Student Stipend
Application Check Sheet

Complete, print, and include this Check Sheet with your stipend materials.
Name   Degree
Institution
Address
Address
City 
State/Country Zip 

Contact Phone
Home Phone
Email
Supervisor
I have previously applied for a student stipend.
Yes      No

 If yes, state the years you applied and if you received support:

 Have you submitted an abstract to ISMRM as the first author?
Yes      No

What is the typical lowest airfare from your city to Kyoto, Japan?
(US$)

 DO NOT release my CV to corporate sponsors?
Yes      No

Recipients of Student Stipends will be required to submit an application for membership in the ISMRM before the funds are disbursed.
Enclosed:
Student's Application Letter
Student's Curriculum Vitae
Abstract and confirmation of online submission
Supervisor's Letter
Eligibility Verification
Membership Application (for nonmembers only)
FOR OFFICE USE ONLY

NO. DATE RECEIVED