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About Your Study

Congratulations on completing your study, funded by a J. Patrick Barnes Grant of The DAISY Foundation. If you are a DAISY Grantee and are applying to present your findings at a professional conference, we will be happy to help you with your expenses, up to $2,000. We will help you fund travel expenses, poster production, etc.

Your JPB Grant Number (if you need to be provided with this number, please email grants@DAISYfoundation.org):

Title of your study:

Institution at which study was conducted:

Date of study completion:

Has your final report been submitted to the DAISY Foundation?

When do you anticipate your final report will be sent to The DAISY Foundation?

Tell us about the conference at which you plan to present. (We will fund one conference per study.)

Name of organization whose conference you are applying to:

Name of conference:

Conference location (city and state):

Conference dates: (mm/dd/yyyy - mm/dd/yyyy):

First name of person presenting at the conference:

Last name of person presenting at the conference:

Title of person presenting at the conference::

Email of person presenting at the conference:

Phone number (555 555 5555) of person presenting at the conference:

Has your abstract or submission been approved for presentation yet?

When do you anticipate hearing from the conference organization about your abstract approval?

Please upload the approval letter from the organization.

Please upload your abstract as submitted to this organization.

Funding Requested

Funds will be dispersed with receipts once you have returned from your conference. Please note how much you estimate your expenses will be below, not to exceed $2,000.

Amount requested for conference registration:

Amount requested for 2 nights of hotel:

Amount requested for round-trip economy airfare:

Amount requested for transportation to/from conference city airport to hotel:

Amount requested for food ($50 per diem for 2 days at maximum):

Amount requested for poster production:

Total amount requested:

Acknowledgement

By checking this box and submitting the online form, you agree to The DAISY Foundation collecting and storing your personal contact information. We may contact you if we have questions about your submission or to discuss next steps. To learn more, please read our Privacy Policy.

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