undergraduate research committee - MSA | Alfaisal Medical Students ...

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Author Affiliation. Oral. Mounted Poster. E-Poster. Other. Mode of Presentation. Have you presented this abstract before
Alfaisal University Medical Students’ Association www.alfaisalmsa.com

undergraduate research committee Funding Form for Presenting an Abstract in a Conference Terms and Conditions: 1. 2. 3. 4.

The applicant must be registered as a full-time student in the College of Medicine. The applicant must be an author on the research paper. The applicant’s affiliation must be College of Medicine, Alfaisal University. Only one student will be funded for each unpublished abstract. No funding can be requested for an abstract that was already funded by URC earlier or published in any journal. 5. The research study submitted to the conference must at least be ready for submission to a journal. 6. The applicant must have no other source of support for attending the conference. 7. Applications for conference funding should be received, in their entirety, no less than 25 working days prior to the conference start date to provide ample time for processing. 8. Each student is entitled to only one funding for presenting an abstract in any conference. Only those students who publish their previous presented abstracts in a journal will be excluded from this condition. 9. The conference funding program is meant to defray the following costs only – visa costs, air tickets, conference registration (not to exceed the student member early bird conference registration rate) and hotel accommodations (either the conference’s recommended hotel or a hotel of equal or lesser value). Funding will not be covered for food, transportation within the conference city, including car rental, or any other personal expenses. 10. Since funds are limited, the CFP only partially funds students for their trip. 11. Not all CFP applications are approved. Only those applications that meet all the above criteria and include a reasonable quote will be reviewed by the URC and forwarded to the CoM for approval.

I agree to all the above terms and conditions.

Alfaisal University Medical Students’ Association www.alfaisalmsa.com

undergraduate research committee Personal Details:

First Name

Middle Name

Last Name Year 1

Alfaisal ID

Alfaisal Email Address

Academic Year

Conference Details:

Name of the Conference

From

To Conference Dates

Country

Title of your abstract

Authorship (First, Second, Corresponding etc.) Oral

Mounted Poster

Author Affiliation E-Poster

Other

Mode of Presentation

Have you presented this abstract before in any other conference?

Yes

No

Alfaisal University Medical Students’ Association www.alfaisalmsa.com

undergraduate research committee Estimated Expenses (Please mention all amounts in SAR only): Visa Fees

SAR

Conference Fees (Early Bird Student Registration Only)

SAR

Air Ticket

SAR

Hotel Accommodation

SAR

Total Expenses

SAR

Are you receiving additional funding for this conference?

Yes

No

If yes, please specify:

Name of the Sponsor

Funding provided in SAR

Alfaisal University Medical Students’ Association www.alfaisalmsa.com

undergraduate research committee Bank Account Details: If your application is approved, you will be notified via email and the approved funds will be transferred to the specified bank account. Please provide accurate bank account details below:

Account Holder’s Name

Name of the Bank

IBAN Number

I hereby state that all the information provided above is accurate and to the best of my knowledge. Name: Date:

For questions and clarifications, contact us at: [email protected]

Alfaisal University Medical Students’ Association www.alfaisalmsa.com

undergraduate research committee For official use, only: Application approved for funding?

Yes

No

If yes, amount approved: SAR _______________ Remarks:

_____________________________________ Director, Undergraduate Research Committee

_____________________________________ Dr. Akef Obeidat Vice Dean, College of Medicine

____________________________________ Dr. Khaled Al-Kattan Dean, College of Medicine