2001 TRAVEL GRANT APPLICATION STUDENT AND YOUNG SCIENTISTS Limited funds are available to help students and young scientists in attending the 2001 Annual ACA Meeting in Los Angeles, CA July 21-26. Preference will be given to those presenting a paper or poster. To apply for assistance, send this completed form, a copy of the abstract you plan to submit and a supporting letter from your research advisor. The deadline for applications is January 31, 2001. Applications received after this deadline will be reviewed only if funds remain after the intial review. The final deadline for applications will be March 2, 2001. Submit Application Via: Student Travel Grant Fund American Crystallographic Association P.O. Box 96, Ellicott Station Buffalo, N.Y. 14205-0096 Fax (716) 852-4846 If using overnight mail send to: American Crystallographic Association c/o Hauptman-Woodward Medical Research Inst. 73 High St., Buffalo, N.Y. 14203 Family Name ________________________________ First Name __________________________________ Dept _______________________________________ Inst_________________________________________ Street ______________________________________ Box/Apt#____________________________________ City _______________________________________ St/ Prov __________Zip/PostalCode______________ Country ____________________________________ Phone ______________________________________ Fax ________________________________________ Title of Paper: ____________________________________________________________________________ ________________________________________________________________________________________ Estimated cost of travel (provide full details): ____________________________________________________ ________________________________________________________________________________________ Estimated cost of meals and lodging (provide full details): _________________________________________ ________________________________________________________________________________________ Endorsement of Research Director: ____________________________________________________________ _________________________________________________________________________________________ _________________________________________________________________________________________  Total amount requested:_______________________  Have you ever applied for an ACA travel assistance grant? ____No ____ Yes, in ____  Have you ever received a travel assistance grant? ____No ____ Yes, in 19__  Are you an ACA member? ____No ____ Yes ATTACH A COPY OF YOUR ABSTRACT TO THIS APPLICATION FORM Signature of Applicant: ___________________________________ Date: ___________________