New Horizons Award


Application


DUE DATE: Monday, February 1, 2010
Mail To: Foundation for Genetic Technology
New Horizons Award
P.O. Box 625
Biloxi, MS 39533-0625

SECTION I- Biographical Information

NAME : _________________________________________________________________________________________

Last First Middle Initial

ADDRESS:_______________________________________________________________________________________

Street City State Country Zip Code

PHONE NUMBER:________________________ SOCIAL SECURITY#_________________________

E-mail Address________________________________

AGT MEMBER #:______________________________

NCA Certification # _______________________ Please enclose a photocopy of NCA card.

Date of initial Certification_________________

SECTION II

Use an attached sheet to submit a one page essay stating your reasons for wanting to attend the annual AGT Meeting.

SECTION III-Certification Statement

I affirm that, to the best of my knowledge, the above statements are correct. I understand that I am responsible for the submission of all required documents within the deadlines. The Foundation for Genetic Technology reserves the right not to process applications found to be late or incomplete.

________________________________________________________ _______________

Signature Date

Foundation For Genetic Technology
New Horizons Award
Application Instructions

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AWARD:

  1. The Foundation for Genetic Technology New Horizons Award consists of $750.00 to help pay meeting expenses, including registration, for the AGT Annual Meeting.
  2. Selection of the award will be made by a Panel of Reviewers.
  3. The decisions of the Panel of Reviewers will be final and reasons for the decisions will not be disclosed.

ELIGIBILITY:

  1. Applicants must be members of the Association of Genetic Technologists.
  2. The Award is open to new technologists who passed their initial NCA exam in the past four years and who are currently NCA certified.
  3. A one page essay explaining the reasons for wanting to attend the AGT annual meeting will be submitted with an application form. NO FAXES WILL BE ACCEPTED.

NOTIFICATION:

  1. The award recipients will be notified by phone by the Chair of the Awards & Scholarships Committee.
  2. A certificate will be presented at the Annual Business Meeting of the Association of Genetic Technologists.
  3. Applicants not selected will be notified by mail.

Application