Letter of Request for Fellowship Travel Grant Application (Required document - click link for printable Fellowship Grant application instructions, including the Letter of Request)
Prepare a SIGNED Letter of Request on ORGANIZATIONAL LETTERHEAD. You will be uploading an electronic version of this document as part of your online grant application. Your letter of request must include all of the following information:

• A request for support a fellow’s travel to a national or international medical/educational meeting related to a disease state of interest to Tibotec Therapeutics.
• Name, Date and Location of the conference, the number of fellows to be supported, and the amount of funding being requested.
• Organization's 9-digit tax ID number.
• Statement verifying that decisions involving the selection of fellows will not include Tibotec Therapeutics.
• Statement acknowledging that there are three or more fellows participating in the organization’s fellowship program.
• A statement of your organization’s status as a teaching institution.
• Name and address to which the check should be made payable and mailed if your request is approved.

Budget (this budget template is required for requests for funding of programs totalling under $100,000. For programs totaling over $100,000, you may use this template or your own.)
The budget must include the following breakdowns (where applicable):

• Fellow travel costs - provide breakdown of registration, hotel, airfare and meals per fellow.

W-9 Form
A signed and dated IRS form W-9 must be uploaded with each grant application (even if submitted with previous grant applications). The information contained in the W-9 form must match that of the organization that would receive funds if the grant were approved.