Travel Grant Application
Saturday, September 27, 2014
Pennsylvania Convention Center
1101 Arch Street, Philadelphia, PA 19107
 
 

Thank you for your interest in a travel grant for the Annual Fall Conference.
We are currently out of funds for travel grants and will not process any applications
after September 8, 2014
.

 
Living Beyond Breast Cancer will provide a limited number of travel grants for this conference.
LBBC is pleased to recognize Triple Negative Breast Cancer Foundation's support of travel grants
for people diagnosed with triple-negative disease.
 LBBC is pleased to recognize Susan G. Komen’s support of travel grants for people diagnosed with breast cancer.
Applications will be reviewed on a rolling basis until funds are depleted.
If you are applying for only a registration fee waiver (no transportation assisance) please click here.   

Eligibility Critera

  • Applicants with a demonstrated financial need who, otherwise, would be unable to participate in the conference.
  • Priority will be given to applicants diagnosed with breast cancer. However, due to a new funding source, first-line priority will be given to travel grant applicants in the following categories: those newly diagnosed with breast cancer within the last two years (2012 to present), those diagnosed with metastatic breast cancer, or those who have not received a travel grant to attend an LBBC conference within the past three years (2011 to present). Limited funds are also available for caregivers and healthcare providers.
  • Travel grants for this conference are open to people living in the United States and Canada.
  • Applicants must agree to use the funds to attend the full conference and will be required to sign in and show photo ID at the Travel Grant Registration table.
  • All Information provided must be accurate. Any invalid information will result in the immediate termination of your application or travel grant.

 

General Information

  • Completed applications should be submitted online using the form below and should be received no later than Thursday, September 18, 2014 (as long as funds are still available).
  • There is a maximum limit to the amount of travel grants this year:
    • $500 for continental United States and Canada residents (up to $184 for hotel reimbursement and up to $316 for travel)
    • $750 for Alaska and Hawaii residents (up to $184 for hotel reimbursement and up to $566 for travel)
  • All applicants must briefly describe their financial circumstances and their need for a conference travel grant.
  • The travel grant funds are provided to help cover airfare, train, bus or car transportation (gas receipts only) and a maximum of up to two hotel nights (50% of the room rate for each night at the Loews Philadelphia Hotel); and/or the conference registration fee up to the maximum limits listed above. NO OTHER EXPENSES ARE COVERED.
  • Travel grant funds awarded may or may not cover all expenses. Cancellation of your travel or other arrangements for any reason is not LBBC's responsiblity.
  • Travel grants provide reimbursement only. No funds will be provided to recipients prior to conference.
  • All travel grant recipients receive an automatic registration fee wavier at the time of their approval. You do not need to fill out the fee wavier application. If you register and pay with a credit card before being approved, you will not receive reimbursement for this expense. No exceptions.
  •  Travel grant recipients receiving lodging assistance must reserve a room at the conference hotel, Loews Philadelphia Hotel, and share a hotel room or pay the cost difference for a single room. A small room block has been secured at the Hotel at a special reduced rate of $159+tax per night [total=$184]. You must make your own reservations. Please reference Living Beyond Breast Cancer to obtain the reduced rate.
  • If the Loews Philadelphia Hotel does not have availability, we have secured a second option block of hotel rooms at the Hampton Inn.  Rooms are at a discounted rate of $169+tax per night [total=195]. If reservations are made at the Hampton Inn, you will still need to share a hotel room or pay the cost difference for a single room. Please reference Living Beyond Breast Cancerto obtain the reduced rate.
  • Obtaining a roommate is the responsibility of the recipient. If you are looking for a roommate, please visit the Events section of ur Facebook page (just search "Living Beyond Breast Cancer" and if you haven't already, "like" us). Once there, join "LBBC Annual Fall Conference Roommate Connections" to connect with other conference attendees. Post messages there to look for a roommate. 
  • Canadian applicants must calculate their expenses in US dollars at time ticket is purchased. All funds will be reimbursed in US dollars. Please visit this site to assist you in your conversion: http://www.xe.com/ucc/. You must list the conversion rate you used on the application.
  • Note: if you are approved for a travel grant and you decide not to attend the conference, please send an email before the conference date to LBBCtravelgrants@leaddogonline.com as soon as possible so that funds can be released and available to other applicants. Not doing so may affect your eligibility for future travel grant opportunities with our organization.
  • Applicants must complete conference evaluation forms and provide a brief testimonial statement that informs LBBC of the impact the conference had on the applicant. By applying for and accepting the travel grant, recipients agree that testimonials may be used on LBBC's website or in future marketing materials.

Notification Process

All applicants will be notified of the status of their application by email or phone within 10 business days from the date the completed application was received. If you have any questions, please send an email to 
LBBCtravelgrants@leaddogonline.com .

PERSONAL INFORMATION
A separate form is required for each person requesting a travel grant.
*indicates required field
You will know you have successfully submitted your travel grant application when you see a picture of three flowers. If this does not appear, re-check the application form and complete the sections in ALL CAPS.
FIRST NAME:* 
LAST NAME:* 
Organization (if applicable): 
ADDRESS:* 
CITY:* 
STATE or CANADIAN PROVINCE:* 
ZIP CODE:* 
EMAIL ADDRESS:* 
PLEASE RE-TYPE YOUR EMAIL ADDRESS:* 
HOME PHONE:* 
Cell phone: 
YEAR OF BIRTH:* 
Race/Ethnicity: White
 Black or African-American
 American Indian or Alaska Native
 Asian or Asian-American
 Pacific Islander
 Hispanic, Latino or Spanish origin
 Multiracial or multiethnic
DO YOU IDENTIFY YOURSELF AS A:*
(check all that apply)
 Individual who has been diagnosed with breast cancer
 Caregiver, family member, friend
 Health professional
If a caregiver, name of associated conference participant: 
Year of breast cancer diagnosis, if applicable: 
WERE YOU DIAGNOSED WITH TRIPLE-NEGATIVE BREAST CANCER?*
Please make a selection.
 Yes
 No
 I don't know
WERE YOU DIAGNOSED WTIH HORMONE RECEPTOR-POSITIVE BREAST CANCER?*
Please make a selection.
 Yes
 No
 I don't know.
WERE YOU DIAGNOSED WITH HER2-POSITIVE BREAST CANCER?*
Please make a selection.
 Yes
 No
 I don't know.
HAVE YOU BEEN DIAGNOSED WITH METASTATIC (STAGE IV) BREAST CANCER?*
Please make a selection.
 Yes
 No
 I don't know.
If you have not been diagnosed with breast cancer, please briefly explain your interest in attending this conference:
EXPECTED EXPENSES
Please indicate only those expenses for which you require assistance.
I NEED FINANCIAL ASSISTANCE TO COVER MY PRIMARY TRANSPORTATION METHOD TO THE CONFERENCE:*
(up to $316 for US or Canada)
(up to $566 for Hawaii or Alaska)
 Yes
 No
If yes, please select which form of transportation you will be using: Airplane
 Train
 Bus
 Car (gas receipts required)
If traveling by air, train or bus, please specify your hometown airport/train station/bus. 
LBBC will reimburse no more than the actual cost for the most economical, non-refundable economy airfare/train fare/bus fare. Please research the best method of transportation and competitive fares before applying.
INDICATE THE COST OF YOUR PRIMARY METHOD OF TRANSPORATION REQUESTED:* 
We reserve the right to adjust your travel grant request based on reasonable roundtrip fares between your departure airport/train station/bus station and the metropolitan Philadelphia area.
COST OF HOTEL REQUESTED:* $92.00 (50% for one night)
 $184.00 (50% for two nights)
 I do not require financial assistance with hotel costs.
Canadian applicants, please indicate the conversion rate used to calculate your expenses: 
BRIEFLY (100 WORDS OR LESS) DESCRIBE YOUR FINANCIAL CIRCUMSTANCES AND NEED FOR A CONFERENCE TRAVEL GRANT.*
BRIEFLY (100 WORDS OR LESS) DESCRIBE HOW YOU WILL UTILIZE THE INFORMATION YOU LEARN IN YOUR COMMUNITY?*
I VERIFY THAT ALL SUBMITTED INFORMATION IS ACCURATE AND VALID.* Yes
I UNDERSTAND THAT...
- I must agree to attend the full conference.
- I must register to attend the conference within five (5) days of my travel grant approval. After five days my award will be cancelled.
- If I register for the conference and pay with a credit card before approval, I will NOT receive reimbursement for this expense.
- I may not receive the entire travel grant amount requested based on funds available, demonstrated need or maximum limit allowed.
- Travel grant funds will not be awarded prior to the conference for any reason. All travel grant funds will be distributed after the conference and only after receipts and supplied reimbursement forms are submitted.
- If I accepted a travel grant in the past and did not attend the conference and did not advised LBBC beforehand, I will be ineligible for future grants.
I HAVE READ AND ACCEPT THESE TERMS.* Yes


NOTE: If you have spam protection on your email account, please add LBBCtravelgrants@leaddogonline.com
to your address book or check your spam folder for a reply to your request.

You will know you have successfully submitted your travel grant application when you see a picture of three flowers. If this does not appear, re-check the application form and complete the sections in ALL CAPS.

If this symbol appears at the top of the page once you submit your form, it means there has been at least one error. Please review the form, especially the required fields marked with an * to make sure that your form is complete and resubmit.