Tropical Disease Institute - Infectious disease links - Biomedical Sciences Department - Ohio University - College of Osteopathic Medicine - Mario J. Grijalva - Chagas - Trypanosoma cruzi

"Improving the health status of underserved populations through sustainable and comprehensive research, service and educational initiatives related to infectious diseases."

TDI Travel Awards Application

First Name:

Middle Initial:

Last Name:

Date of Birth:

(mm/dd/yyyy)

Email Address:

Confirm Email:

Phone Number:

(include area code)

School:

Ohio University
other -- specify:

College (i.e., Arts and Sciences, OU-COM, Education, etc.):

Rank of Applicant:

Undergraduate:	Freshman Sophomore Junior Senior
Graduate:	Masters Doctoral
Medical Student:	Year I Year II Year III Year IV
Other:	specify:

Program of Interest:

	Tropical Disease Research: Chagas Disease in Ecuador

(There is only one eligible program this year.)

Have you submitted an application to the program? yes no

Upload Essay:

For more information contact Dr. Grijalva at grijalva@ohiou.edu

Ohio University
College of Osteopathic Medicine
Irvine Hall, Athens, Ohio 45701
740-593-2530 740-597-2778 fax

Last updated: 02/27/2012