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IMA Program Application Form

To request an invitation to an IMA program, please fill-out the following application and upload any required documents mentioned below.

Funding is limited and requires completion of the Funding Request portion of the form. If the event your are interested in does not appear in the list you may request participation without IMA funding by e-mailing visit@ima.umn.edu. There are no registration fees for IMA programs.

To apply for a visit of one month or more, complete the General memberships application.

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Program Title:
APPLICANT INFORMATION [* fields are required.]
First Name*:
Middle Name:
Last Name*:
Position*:   

Organization*:
Search by keyword:   
Department(if applicable):
Mailing Address:
Street Address Line#1:
Street Address Line#2:
City:
State:
Country:
Zip Code:
E-mail*:
Home Page URL(if any):
Phone*:
Fax:

Highest educational degree*:         
Primary field of interest*:
Year awarded*:

Gender*:   
Race/Ethnicity*:






Country of Citizenship:
Country of Residence:
If not US citizen are you a US permanent resident?: Yes   No

Referred by:

If not referred, how did you hear of this program? 

REQUESTED PERIOD OF STAY

The stay should normally coincide with the workshop dates plus reasonable travel arrangements. For stays extending beyond this time-frame, please provide justification in an email. For a visit of one month or more, see the IMA memberships page.

Arrival Date*: (YYYY/MM/DD)
Departure Date*: (YYYY/MM/DD)

FUNDING REQUEST

Some limited funding may be available for participation. Indicate your funding request and provide justification below. Participants from IMA Participating Institutions and Corporations may be eligible for funding from their institution's membership account.

Please indicate if you are requesting funding*:




Describe any other support for this travel you will be receiving or have applied for:

Please read about our reimbursement policies.


SUPPORTING INFORMATION

Curriculum vitae including list of publications.
Personal statement describing scientific interests, research plans, and reasons for wishing to participate.




    

Thank you for your interest in IMA Programs.

Equal Opportunity Statement

The University of Minnesota is committed to the policy that all persons shall have equal access to its programs, facilities, and employment without regard to race, color, creed, religion, national origin, sex, age, marital status, disability, public assistance status, veteran status, or sexual orientation.

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