Application for Nils Møller Andersen Award


Applicant's Name _________________________________ Date ___________________

Affiliation/Address ________________________________________________________

________________________________________________________________________

E-mail Address____________________________________________________________

Title of Research Presentation at IHS Quadrennial Meeting:________________________

________________________________________________________________________

Author(s) _______________________________________________________________

Amount Requested   __________

Detailed travel plans _______________________________________________________

________________________________________________________________________

________________________________________________________________________

Estimated Travel Costs:

Registration          ___________

Lodging               ___________

Transportation      ___________

Meals                   ___________

Other                   ___________

Other funds received, applied for, or anticipated _________________________________

________________________________________________________________________

________________________________________________________________________

Applicant's Signature ______________________________________________________

If applicant is a student:

Faculty Research Advisor's Signature _________________________________________

*Please attach an abstract of the research to be presented, not to exceed 250 words*
*Applicant's curriculum vitae and one letter of reference are also required*

Contact information:
Dr. Paula Levin Mitchell, Secretary, IHS
Department of Biology
Winthrop University
Rock Hill, SC 29733 USA
FAX: 1-803-323-3448 mitchellp@winthrop.edu

Print this page and and submit it with
the requested documents to the above contact information.
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