Resident Travel CME form
Once your travel has been approved please complete this survey.   To verify CME funding balances at any time of the year, please contact your lead coordinator.  PGY 1 & 4, Marisol Xelo; PGY 2 & 3 Christy Poppe.
 
You must select a hospital travel request and fund number 0166-2210.  
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Email *
Name *
Traveling to
Reason for travel
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Department funding
Presenter & First Author at a National Conference $1000
Presenter & First Author at a Regional  Conference $750 
Elected EMRA $1000
Elected  Chair/Vice at a national conference $1000
Active member EMRA/SAEM committee $250
NY ACEP 
I will use my residency cme (Enter amount)
GME stipend:  You must complete before travel.  (For presenters only)  GME office will send an acceptance email.  You must complete a 1 page summary when you return from your trip.  The $500 stipend will be applied to your travel voucher.  You will not receive a check for $500.  Please upload acceptance letter to your travel voucher.



Amount to be funded for your trip
Comments *
A copy of your responses will be emailed to the address you provided.
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