DEADLINE INFORMATION: All Complete Application Packets for a FASEB DREAM Mentored

The FASEB “Diversity Resources for Enrichment, Access & Mentoring” (DREAM) Mentored Poster/Platform Presenter Travel Awardis available for first-time attendees/presenters and presenters who want a mentored meeting experience at the IMMUNOLOGY 2017TM meeting. The award is not transferable without proper documentation and authorization. You may not apply for a FASEB DREAM award if you are receiving funding from any other sponsoring organization. Applicants must not at any time be staffing an exhibit booth/display at the meeting. Violation of this policy during the meeting will invalidate your award.

DEADLINE INFORMATION: All complete application packets for a FASEB DREAM Mentored Poster/Platform Presenter Travel Award must be received no later thanApril 7, 2017 (5PM EST) extended. Late and/or incomplete application packets will be declined upon receipt.

*indicates required response

* TYPE OF AWARD REQUESTED: Select Award RequestedMentored Travel AwardLocal Area Mentored Award_Meeting Reg ONLY

* Applicant Eligibility Category: Select Applicant StatusUndergraduate StudentGraduate/PhD StudentMedical StudentPostdoctoral FellowClinical Trainee/Fellow

* Name: Enter First and Last Name

* Gender: Select Gender IdentityFemaleMale* Degree/Title: Select Degree/TitleDr.Mr.Ms.Mrs.MD/PhDPhD

* Institution: Enter Institution's Name * Department: Enter Department

* Address: Enter Address

* City: Enter City * State: Enter State Code * ZIP: Enter ZIPCode

* Email: Enter E-mail Address* TEL: Enter Contact Phone# FAX: Enter Fax#

Therequested information is required for follow-up program evaluation data and must be provided by applicant.
* Home Address: Enter Home Address

* City: Enter City * State: Enter State Code * ZIP: Enter ZIPCode

* Do you give FASEB permission to send future emails about: Please select one...FASEB onlyFASEB MARC/Diversity Programs onlyI don't want to receive any emails.
* Are you 18 years or older and give permission to FASEB or a FASEB-approved evaluation consultant to contact you about future studies involving FASEB DREAM travelaward recipients? Select YES or NOYESNO

ABOUT THE FASEB DREAM MENTOREDTRAVEL AWARDS: APPLY EARLY!! FASEB is offering awards for eligible underrepresented students and postdocs/trainees to help defraymeeting registrationand/or travel-related expenses associated with attending the IMMUNOLOGY 2017TM meeting. These funds are meant to defraythe cost of meetingregistration, lodging, air/ground transportation expenses, and per diem allowance (if applicable). Full-time undergraduate/graduate-PhD students, medical students, clinical trainees and postdoctoral fellows(who are identified as being from a group considered underrepresented in the biomedical and behavioral sciences) are eligible to apply for the trainee awards. Full-time undergraduate/graduate-PhDstudents, medical students, clinical trainees and postdoctoral fellows at accredited minority institutions are also eligible to apply for mentoredtravel awards. These are federally-funded awards and are restricted to USA Citizens/Legal Permanent Residents of the USA. The amount of the award is up to $1,850 maximum for the IMMUNOLOGY 2017TM meeting participation and must be applied to related expenses including travel (air and ground transportation) and meeting registration.

Type of awards available include: 1)Mentored Poster/Platform Presenter Travel Award; 2)Mentored Poster/Platform Presenter Registration Only Award (for local area meeting participants).

The awards will be processed as reimbursements to the award recipientsafter the meeting is over. Original receipts will be required in order to receive reimbursement. The maximum amount to be reimbursed for meeting- and/or travel-related expenses will be indicated in the award recipient’s award letter.

Details about the Mentored Meeting Activities related to the FASEB DREAM Mentored Travel Awardsare available on the last page of this application packet. This is a MANDATORY participation award. DO NOT apply for the FASEB DREAM Mentored Award if you do not wish to participate, or are not certain about your ability to participate in the structured mentoring program and activities as described on the last pages of this application form. If you apply and are approved to receive a mentored poster/platform presenter award and later change your mind about participating in the structured mentoring program and activities, your entire award will be rescinded and cancelled completely, and you will not be reimbursed for any expenses you have already incurred/or will eventually incur. Please indicate your understanding and acknowledgement of the restrictions and guidelines for this FASEB DREAM Mentored Poster/Platform Presenter Award on the next page of this application form.

PLEASE COMPLETE ALL QUESTIONS LISTED BELOW *indicates required response

1)*I am applying for the FASEB DREAM Mentored Poster/Platform Presenter Travel Award for the IMMUNOLOGY 2017TMmeeting. I have read the requirements for this award. I understand and agree to participate in all mandatory and structured mentoring program activities affiliated with this award and will forfeit my award if I choose not to participate in the required activities during the IMMUNOLOGY 2017TM meeting. Select YES to indicate your agreement.YES

2)*Are you an individual from a background or group identified as being underrepresented in the biological and behavioral sciences? Select YES or NOYESNO

3)*Please indicate Underrepresented Group Select Underrepresented GroupDisability: Mental ImpairmentDisability: Physical ImpairmentEthnic: Alaskan NativeEthnic: American Indian/Native AmericanEthnic: Black/African AmericanEthnic: ChicanoEthnic: HispanicEthnic: LatinoEthnic: Pacific Islander (Hawai'i)Ethnic: Pacific Islander (Guam)Other (if Group/Ethnicity not listed)

** If “American Indian/Native American” selected, please specify tribe and provide a copy of tribal affiliation certificate.
TRIBE: Specify Tribe

** If “Other” selected, please specify -Specify Other Ethnicity Or Underrepresented Group

4)* Citizenship/Residency Status: Indicate Citizenship/Residency StatusUSA CITIZENLEGAL PERMANENT RESIDENT OF USA

** If “USA Citizen,” provide a photocopy of one of the following: 1) Identification page of your valid USA Passport, 2) Birth Certificate,

Certificate of Naturalization, 4) Certificate of United States Citizenship, or 5) Consular Registration of Birth Abroad Form withthis

application.

** If “Legal Permanent Resident of USA,” provide a photocopy of your “Green Card” with this application.

NOTE: The above documents are requested for verification purposes only. After citizenship or permanent residency status has been

confirmed by FASEB DREAM Program staff, the documents are destroyed through a secure shredding process.

5)*Have you ever attended anIMMUNOLOGY/AAI AnnualMeeting? Indicate YES or NOYESNO

If “Yes,” how many times? Indicate Your Selection123 OR MOREN/A

6)*Are you funded by an NSF, NIH or other federally-funded Program at your university?Indicate YES or NONOYES
If “YES”, please indicate the type of federal grant: Indicate Federal Grant TypeF30: NRSA Predoctoral MD/PhD FellowshipF31: NRSA Predoctoral FellowshipF32: NRSA Postdoctoral FellowshipF33: NRSA Individual Senior FellowshipsT32: NRSA Institutional Research Training GrantT35: NRSA Short-Term Insitutional Res TrainingT34: NRSA MARC U-STAR (Undergraduate)K01: Mentored Research Scientist Development AwardK02: Independent Scientist AwardK05: Established Investigator Award in Cancer PrevK07: Academic Creer AwardK08: NIH Mentored Clinical Scientist Career DevK12: Mentored Clinical Scientist Development ProgK22: Transition Career Development AwardK25: Mentored Quantitative Research Career DevelK23: Mentored Clinical Career Development AwardsK99/R00: Pathway to Independence AwardR25: Initiative for Maximizing Student DevelopmentR25: Postbaccalaureate Research Education ProgramR25: Research Initiative for Sci Enhancement**Not Listed**
If “YES” and your funding type is not listed, enter grant info/number: Enter Grant Info/Number

7)*Final Career/Long-term Terminal Degree Desired or Earned: Indicate DegreeBA/BSMSMDPhDOTHER COMBINED PROFESSIONAL DEGREE/PhD
If “Other” selected, enter other degree:Specify Other

8)*UNDERGRADUATES ONLY: Are you planning to pursue a career in biomedical research? Not an UndergraduateYESNOUNSURE

9)*What is the total number of days you are planning to attend the meeting? # of Days (exclude travel days)0123456

10)*Are you a FASEB Society Member? Indicate YES or NOYESNO
*If “Yes,” indicate Society: Indicate SocietyAAAAAIABRFACSMAFMRAGEAMPAPSAPepSASBMBASCIASHGASIPASNASBMRASPET(See next list for additional societies)Indicate SocietyBMESESGSAHCSISCBPSSDBSEBMSFGSFRBMSPRSSRTSUSHUPO

Americans with Disabilities Act - For Applicants Who Self-identified as “Disability: Mental” or “Disability: Physical” as an Underrepresented Group in #3 above: An individual with a physical or mental impairment that substantially limits one or more major life activities is eligible to apply for this award. Please list any disabilities that would require reasonable accommodation and the attention of the program organizers. List any devices/services that would enhance your ability to participate in the selected scientific meeting. Please explain in detail.

The FASEB DREAM Program is funded by grants from the NIGMS/NIH. T36 GM0008059-32NCE and R25 GM116706-01

ELIGIBLE UNDERGRADUATE/GRADUATE-PhDSTUDENTS, MEDICAL STUDENTS, CLINICAL TRAINEES AND POSTDOCTORAL FELLOWSWHO WISH TO BE CONSIDERED FOR FASEB DREAM MENTORED POSTER/PLATFORM PRESENTER TRAVEL AWARD FUNDING MUST:

1)Be a USA Citizen or a Legal Permanent Resident of the USA. (A copy of one of the following: USA Passport ID Page, Birth Certificate, Certificate of Naturalization, Certificate of United States Citizenship, Consular Registration of Birth Abroad, or Permanent Resident “green card” is required.)

2)Register early for the meeting. (FASEB reimburses at the advance registration fee rate.)

3)Follow abstract submission guidelines. Submit your abstract and appropriate materials by the deadline date for IMMUNOLOGY 2017TM. NOTE: When you receive your notification letter indicating that your research abstract will be programmed and included as a poster or oral presentation as part of the IMMUNOLOGY 2017TMProgram, you may complete the application process by submitting the confirmation letter ASAP, and prior to 14 calendar days before the start of the IMMUNOLOGY 2017TM meeting. Failure to complete this process will void your FASEB DREAM Mentored Poster/Platform Presenter Award application.

4)Complete and submit this application form including all supporting documentation.

1. A copy of your letter of confirmation of programmed poster/oral presentation (within 48 hours after notification of your confirmed programmed abstract.)
2. A copy of your extended abstract. (See extended abstract sample information available at
3. A letter on departmental letterhead signed by your mentor, chair or dean that affirms your academic student or postdoc status, and requests consideration for a FASEB DREAM Mentored Poster/Platform Presenter Travel Award for you. Be sure to include the contact information of your mentor, chair or dean.
4. A copy of your current CV/resume including all sources of funding you are receiving/have received.
5. A one-page statement demonstrating financial need and identifying potential benefits to be gained (in addition to presenting and discussing your research at the meeting) and the anticipated effect this may have on your career goals.

5)Submit any required documentation (copy of green card, tribal affiliation certificate, USA Passport ID page, etc.) if applicable.

All award applicants must be approved by the FASEB DREAM Program review committee. Extended abstracts submitted and accepted as poster or platform presentations will be used as the basis for the awards. The FASEBDREAM Program review committee will select the award recipients based on all supporting documentation from applicants who are eligible for funding as specified by the National Institute of General Medical Sciences, National Institutes of Health (NIGMS/NIH.) In addition, preference will be given to FASEB Society members. Funding for the awards is contingent upon funding availability. Apply early! Applications will be reviewed and approved on a rolling basis.

Applicants selected to receive an award will be notified by the FASEB DREAM Program staff upon approval of their application.

SUBMIT APPLICATION TO: FASEB DREAM Program Manager at , or via USPS: FASEB DREAM Program; ATTN: IMMUNOLOGY 2017TM/FASEB DREAM Mentored Travel Award; 9650 Rockville Pike; Suite L-6412, Bethesda, MD 20814-3998.

The FASEB DREAM Program is funded by grants from the NIGMS/NIH. T36 GM0008059-32NCE and R25 GM116706-01

FASEB DREAM MENTORED POSTER/PLATFORM TRAVEL AWARD APPLICATION CHECKLIST

Completed Award Application Form
Copy of Confirmation/Notification of Abstract Acceptance for Meeting Program.
(See #4 above regarding abstract submission and confirmation information.)
Copy of Extended Abstract
Letter of recommendation from Mentor, Chair or Dean
(MUST accompany your application packet at time of submission, otherwise your application will be
declinedbecause the packet will be an incomplete submission.)
Copy of CV/Resume including all sources of funding you are receiving/have received.
One-page statement detailing the benefit you will receive by participating in the meeting.
** If USA Citizen, copy of USA Passport ID Page, Birth Certificate, Certificate of Naturalization, Certificate of
United States Citizenship, or Consular Registration of Birth Abroad
** If Legal Permanent Resident, copy of ‘Green Card’
** If American Indian/Native American, copy of Tribal Affiliation Certificate/Card
If applicable, include disability statement and ADA-related reasonable accommodation request.

PLEASE BE ADVISED: WE DO NOT ACCEPT PIECEMEAL SUBMISSIONS. ALL INCOMPLETE OR LATE APPLICATION PACKETS WILL BE DECLINED UPON RECEIPT.

A specialized mentoring program to provide resources, opportunities, mentoring, and professional development for students from *underrepresented groups in science, technology, engineering and mathematics.

Goal: Provide engagement and structured mentoring for students attending The American Association of Immunologists (AAI) annual meeting, IMMUNOLOGY 2017TM , May 12-16, Washington, DC.

The FASEB “Diversity Resources for Enrichment, Access & Mentoring 2” (DREAM) mentored travel awards will be offered to first-time meeting attendees and presenters (trainees selected to give a poster or platform presentation during the IMMUNOLOGY 2017TM meeting) who meet FASEB DREAM travel award application requirements and who wish to partake in structured mentoring assistance at the AAI meeting.

Mentoring and Engagement for FASEB DREAMTravel Award recipients attending IMMUNOLOGY 2017TM

Pre-meeting:

1. AAI will reach out to student awardees to:

• establish awardees’ career interests in order to better tailor on-site mentoring activities to their professional development needs
• advise awardees of the three MAC-sponsored sessions/activities they are required to attend, and of the requirement that awardees register for the meeting and for the MAC-sponsored Careers Roundtable & Networking Session
• encourage on-site peer mentoring among awardees at other opportunities during the meeting, including the Opening Night Reception
• invite awardees to submit in advance of the MAC Roundtable the career questions/issues of primary concern they plan to bring to the session

2. AAI announces travel award recipients on website and in print program, and MAC plans brief recognition of awardees to occur at the AAI MAC Careers Roundtable and Speed Networking Session and AAI Vanguard Lecture.

On-site:

1. Awardees attend the meeting’s Opening Night Reception (optional) – Meeting Day 1

• Attendees will have the opportunity to meet peer awardees to coordinate plans to attend meeting sessions of common interest and co-network during the conference.

2. Awardees attend AAI MAC Careers Roundtable and Speed Networking Session (required) – Meeting Day 2

• Awardees will be acknowledged with names/photos displayed and asked to stand and be recognized at the outset of the session.
• The roundtable will afford awardees the opportunity to meet in small-group format with accomplished, senior immunologists to explore their experiences and ideas on handling specific career challenges.
• The session includes a speed networking component which allows attendees to practice networking in a relaxed environment offering a structured networking exercise and personalized feedback on communicating their scientific interests/objectives most effectively.
• The session concludes with an informal discussion period during which the awardees will come together to meet each other and ask questions of the session table leaders, comprised of current and past MAC members and their colleagues.

3. Awardees attend informal networking event that includes MAC Roundtable leaders and attendees (required)–Meeting Day 2

• This gathering will afford FASEB DREAMTravel Award recipients an opportunity to continue, in a relaxed setting, beneficial networking interactions with senior immunologists and peers, discuss research interests, and engage in discussions about career development.

4. Awardees attend AAI MAC Vanguard Lecture (required) – Meeting Day 4

• Awardees will experience a proud AAI tradition dating to 2003. Since that year, the AAI meeting has featured a scientific lecture presented by an AAI member who is an underrepresented minority investigator. Selected for their achievements in the field of immunology, presenters are among the most prominent investigators in the field and models of successful career development.
• At the outset of the session, awardees will be acknowledged with names/photos displayed and asked to stand and be recognized.
• During the session’s closing Q&A period, awardees will have the opportunity to ask questions of the lecturer and/or engage in session discussion with MAC members, colleagues, and peer awardees in attendance.

5. Awardees will attend other scientific and career development sessions as determined by the award recipients’ immunology and career interests. The AAI meeting is the world’s leading all-immunology event and offers the latest developments in all areas of the field. The meeting additionally provides a wide range of sessions to support the career development of students and postdoctoral fellows. These include workshops, roundtables, and panel discussions to explore specific career topics and issues, including How to Convert Your CV into a Resume, Interviewing for a Job, Secrets for a Successful Postdoctoral Fellowship, Careers in Biotech Panel Discussion and Networking, and more.

Post-meeting:

1. FASEB DREAM/AAI sends exit survey trainees to ascertain what worked well and what can be improved.