Charles D. Watts, MD, Travel Award Application | Duke University School of Medicine

Complete this form in its entirety and attach the complete Budget Summary

Submit the Proposal and Budget Summary via email to [email protected] or in person to the Multicultural Resource Center, 4020 Trent Semans Center.

Questions should be emailed to [email protected] or call (919) 684-5882.

First Name*

Last Name*

Duke Unique ID#*

Email Address

Title of Project:

Website (if applicable)

Project Start Date

Project End Date

Have you previously received funding from the Multicultural Resource Center?

yes

If yes, please list the dates, project name, travel destination, and amount awarded.

Project Description: Summarize the project’s purpose. What needs, concerns, and issues does it address? How will this experience enhance your understanding of cultural competence, health disparities and/or global health. (For away rotations, please attach acceptance documentation from the site and permission documentation from Student Affairs.)

What are the specific GOALS of the project? What do you hope to achieve with this project?

Describe each goal, including how you will know the extent to which it has been met.

Have you requested or received additional financial support for this project?

If so, please list other sources you have pursed and indicate whether you received funding:

Additional Comments

Upload Budget

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2 MB limit.
Allowed types: pdf, doc, docx, xls, xlsx, .

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