Research Presentation Reimbursement Packet Please check each of the - PDF document

Research Presentation Reimbursement Packet Please check each of the following as completed and include this check sheet with each submission for research reimbursement requests 30 days prior to conference The Director of the GME office needs to review and approve the UMKC Resident/Fellow Research Presentation Fund form, signed by both the Resident or Fellow and Program Director, along with official documentation of acceptance as first author and conference agenda. A single funding request per Resident per academic year will be considered at the rate of $500.00 for regional support and $750.00 for national and international support. Research funding is limited and consequently is not guaranteed and only available until exhausted. Approval status will be sent to the requesting resident or fellow as well as the Program Coordinator via UMKC email address. A copy of the signed and approved UMKC Resident/Fellow Research Presentation Fund form is to be submitted with the final request for reimbursement within 30 days of returning from the research convention. Requesting reimbursement after conference 1. Request for Research Funds form (included in this packet), completed and signed by Resident/Fellow, Program Director, and GME Director 2. Travel Request Form completed and signed by Program Director (form included in this packet) 3. Copy of meeting schedule of events to include location of conference and your participation highlighted 4. Original, itemized receipts that show proof of payment 5. Complete detailed expense section (included in this packet) Requests received by the Business Office exceeding the 30 days may be subject to taxation. Name: _____________________________ Contact number: ___________________________ Submit completed reimbursement packets to your Residency Program Office for submission by the program: School of Medicine Business Office (M5-105) 2411 Holmes Street Kansas City, MO 64108-2792 Date stamped when received by the Business Office Updated 1/7/15

REQUEST FOR RESEARCH FUNDS UMKC RESIDENT/FELLOW RESEARCH PRESENTATION APPROVAL (PLEASE TYPE & PRINT) Request Date: Name: PGY: Program: Conference/Meeting Name: Conference/Meeting Dates: Begin: End: Location: Title of Paper/Poster Presented: Co-Author(s): Presentation Date(s): Plans for Publication: Check Total Funds Requested : Regional - $500.00 National - $750.00 International - $750.00 Have you received funding from any other source for this conference? YES NO If Yes, from whom and for how much? Supporting Schedule of Conference/Meeting is attached . Signature of Resident/Fellow Date Signature of Department Chair or Program Director Date Signature of GME Director of Operations Date

Travel Request Form F ORM MUST BE APPROVED BY P ROGRAM DIRECTOR IN ADVANCE OF TRAVEL AND SUBMITTED TO THE B USINESS OFFICE WITH EACH REQUEST FOR REIMBURSEMENT Name: _____________________________ Program: ___________________________ PGY: ______ Conference name/title of activity: ________________________________________________________ Location: ____________________________ Begin/End dates: _______________________________ The purpose of travel is: If business meal, number and type of attendees: Estimated Itemized expenses are as follows 1. Air and Ground Transportation ______________________ 2. Lodging ______________________ 3. Conference Fees ______________________ 4. Meals and Incidentals ______________________ Total Estimated Expenses ______________________ Funding Source:  Resident Education Funds $___________  Research Presentation Funds $__________  Program Training Funds $___________ ___________________________________ ___________________________________ Resident/Fellow Signature/Date Program Director Signature/Date

Per Diem Expense (airfare, registration, lodging, etc.) Amount estimate List each expense separately at $42 per day* $ $ $ $ $ $ $ $ $ $ $ Mileage Allowance Miles: at the rate of $0.545 per mile to the nearest mile $ Total $ Time travel Time travel If requesting meal ended started reimbursement (HH:MM a/pm) (HH:MM a/pm) *Details for specific city rates, see http://www.defensetravel.dod.mil/site/perdiemCalc.cfm