US ICAM Junior Exchange Award Track II (Mentor Driven)

I2CAM

Please submit your application at least two months prior to your planned research trip. This will allow considerable time to review your application.

*All fields are required unless otherwise specified.
A. Primary Mentor Information
 

  ( optional )

 

 

  ( optional )

 

 

 

 

 

 


Demographic Information
Gender
Female
Male

Race/Ethnicity: (Check all that apply)
American Indian or Alaska Native
Asia
Black or African American
Native Hawaian or Other Pacific Islander
White
Do not wish to provide

Citizenship: (Check one)
US Citizen
Permanent Resident
Other Non-US Citizen
Do not wish to provide

Disability Status: (Check all that apply)
Hearing
Visual
Mobility/Orthopedic Impairment
Other
None
Do not wish to provide
Publications
 

 


*All fields are required unless otherwise specified.
A. Secondary Mentor Information
 

  ( optional )

 

 

  ( optional )

 

 

 

 

 

 

Publications
 

 


B. Additional Information
A one-two page research proposal including the planned arrangements with the research groups at the two different ICAM institutions. Indicate possible candidates for the Award if you have them in mind. Proposal must indicate and justify the proposed (2-6 month) duration of the visit.
Description of the proposed travel activity, and how it will benefit you.  

Date Estimates
Please provide an explicit estimate of the dates and duration of the award