HSC OfDEI Professional Development Support Request

This form is used when an individual wants to request funding from the UNM HSC Office for Diversity, Equity & Inclusion for conference travel or professional development activities (HSC Learners Only).

For best consideration of sponsorship, please apply at least 45 days prior to the event date(s).

A DEI team member will confirm the receipt of your request. Due to the number of requests received by our office, we must limit the amount of support to $250.00 per trainee.

***Please note that funds are only for DEI-focused activities and are limited annually based on budget availability.

REMINDERS

OfDEI MISSION: To advance inclusivity, diversity, & equity throughout the Health Sciences Center and New Mexico via capacity building, sustainable programs, and collaborations. We also strive to promote inclusivity and diversity throughout the UNM Health Sciences Center as well as seeking to engage communities across New Mexico to advance health equity through programs and sustainable, collaborative partnerships.

URGENCY: If your request is URGENT, please be sure to click on the URGENT FLAG in the form below! We will do our best to meet your needs, but be aware our review process does take some time, so please try to plan ahead and send in your request EARLY!

REQUESTING INDIVIDUAL/ORGANIZATION INFORMATION

Requestor Name

Please enter your FIRST & LAST NAME

Contact Email

Please be sure you enter a valid email address that you check regularly!

Contact Phone

Please enter your phone number in this format XXX-XXX-XXXX

Trainee Type

Health Sciences Entity Affiliation

Request Type

EVENT/PROGRAM/CONFERENCE INFORMATION

Event/Program/Conference Title

What is the name of the program/event/conference for which you are requesting funding?

Location of Event

City & State

Date(s) of Event

Example: April 1-3, 2024

Reason for Attending

Limit to 100 words or less.

If DEI-focused, please explain.

Are You Presenting at the Conference?

Yes

Do You Hold a Leadership Role in the Organization Holding the Event?

Yes

Not Applicable

Have You Participated in Any UNM Health Sciences Office for DEI Pathway Programs

Example: PATH, Dream Makers, Health Careers Academy, UHSEP, ClinEd, Ambassadors, Scholars, Test Prep, PrEP

Yes

FUNDING REQUEST SPECIFICS

Total Requested Funding Amount

Please format your response as follows $00.00 (ex: $250.00). Maximum request amount for HSC Professional Development Funds requests is $250.00.

Registration Cost

Transport Cost

Lodging Cost

Other Costs?

If You are a Trainee in a Graduate Program, Have You Received Approval From Your Department and/or Advisor to Attend this Event?

Yes

Not Applicable

Have You Requested Financial Support from Other UNM Departments/Units to Attend the Event?

Yes

Have You Received a Commitment of Financial Support from Other UNM Departments/Units to Attend this Event?

Yes

Has UNM Health Science Office for DEI Financially Supported You in the Past?

Yes

URGENCY DETERMINATION

If you require an approval status response in fewer than 10 working days, please check the box. If not, please leave the box blank.

Is This Request URGENT?

What is Latest Possible Notification Date?

What is the latest date by which you need to receive approval status notification from OfDEI?

mm/dd/yyyy

FILE UPLOADS

You are welcome to attach files related to this request and a variety of file types are acceptable (PDF, Word, Excel, JPG, PNG, etc.). Examples might include flyers, annual reports, etc.

Drop your files here

Send me a copy of my responses

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