John K. Robinson Grant Application Form

The UMMSM Medical Alumni Association provides the John K. Robinson grant in memory of the contributions Kenneth D. Keusch, M.D. ’63 made to students, to the University, and to the field of radiology.

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Name of your Faculty P.I. {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

Please download the Faculty Member Statement of Support Form and attach it using the file upload tool located to the right of this box.

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Date and duration of your research {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

Goals of project and expected outcome {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

Description of project activities performed {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

Total funds requested ($500 Maximum) {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

Itemized breakdown of total funds requested (flights, hotel accommodations, transportation, registration fees, etc.) {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

Please attach the following documents when submitting application. If there are any questions, please contact alumni@med.miami.edu:

Conference Acceptance Letter
Completed Faculty Member Statement of Support Form
Presentation
Abstract, if available

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John K. Robinson Grant Application Form

Are you the primary author on the project? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

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Have you been awarded this grant before? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

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Is your conference date MORE THAN 30 days from today’s date? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

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Is the JKR grant application related to a poster presentation? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

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Name {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

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Degree Program and Graduation Year {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

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Email {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

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Name of Conference {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

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Date and Location of Conference {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

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Title of Proposal {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

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Name of your Faculty P.I. {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

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Please download the Faculty Member Statement of Support Form and attach it using the file upload tool located to the right of this box.

Upload your completed 'Faculty Member Statement Form' {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

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Date and duration of your research {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

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Goals of project and expected outcome {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

Description of project activities performed {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

Total funds requested ($500 Maximum) {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

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Itemized breakdown of total funds requested (flights, hotel accommodations, transportation, registration fees, etc.) {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

Please attach the following documents when submitting application. If there are any questions, please contact alumni@med.miami.edu:

Conference Acceptance Letter
Completed Faculty Member Statement of Support Form
Presentation
Abstract, if available

Upload the documents listed in the itemized list to the left {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding Name, mode=oneTime}

{binding Description}

John K. Robinson Grant Application Form

Are you the primary author on the project? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

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Have you been awarded this grant before? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

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Is your conference date MORE THAN 30 days from today’s date? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

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Is the JKR grant application related to a poster presentation? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

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Name {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

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Degree Program and Graduation Year {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

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Email {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

Name of Conference {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

Date and Location of Conference {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

Title of Proposal {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

Name of your Faculty P.I. {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

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Please download the Faculty Member Statement of Support Form and attach it using the file upload tool located to the right of this box.

Upload your completed 'Faculty Member Statement Form' {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding Name, mode=oneTime}

{binding Description}

Date and duration of your research {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

Goals of project and expected outcome {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

Description of project activities performed {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

Total funds requested ($500 Maximum) {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

Itemized breakdown of total funds requested (flights, hotel accommodations, transportation, registration fees, etc.) {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

Please attach the following documents when submitting application. If there are any questions, please contact alumni@med.miami.edu:

Conference Acceptance Letter
Completed Faculty Member Statement of Support Form
Presentation
Abstract, if available

Upload the documents listed in the itemized list to the left {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

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