LEA-WH Fellowship Cohort 1 - Travel Grant Reporting Form

Welcome and Instructions
Thank you for your engagement with professional development opportunities supported through the LEA-WH fellowship travel grants. We are glad that our fellows are able to use these funds to access meaningful professional networking and collaboration opportunities, including conferences, workshops, meetings with collaborators, and other relevant events.

Through this form, we collect information about travel grant-supported activities so we can better understand how these opportunities contribute to fellows’ professional growth, networking, and broader fellowship impact. This information may also help us share insights with program partners and sponsors.

Before completing the form, it may be helpful to collect the following information:

Name, date, and location of the event or activity.
Written description of the activity and your role or participation (2-4 sentences).
List of new collaborators or notable professional contacts, if applicable.
Description of key outcomes, connections, or takeaways from the activity.
Photo(s) from the activity, if available.
Link to any related website for the event.

We appreciate your time and thoughtfulness in completing this form.

Please submit one form per travel grant-supported event within two weeks of returning from your trip.

1. Name *This question is required.

2. Title of event (may be shared publicly, please list formal title). *This question is required.

3. Event location (Ex. City, Country) *This question is required.

4. Event start date *This question is required. This question requires a valid date format of MM/DD/YYYY.

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5. Event end date *This question is required. This question requires a valid date format of MM/DD/YYYY.

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6. Please provide a brief description of the event that we may share publicly (2-4 sentences, written in third person).

Example: On February 6–7, 2026, LEA-WH Fellow Name attended the (Event Name) on (Topic/Event Title). Senior leaders from government, academia, industry, philanthropy, and the health sector convened with experts to discuss key issues shaping women’s health, including gaps in research, access to care, health equity, innovation in prevention and treatment, and opportunities to strengthen the women’s health workforce.

(LEA-WH Fellow Name) contributed to these conversations from the perspective of a women’s health fellow and early-career professional. She also engaged with leaders and participants to gather insights, contacts, and resources relevant to her work in advancing women’s health research, policy, and practice. *This question is required.

7. Please provide a link related to this event that we can share for more info.
Example: event pages, feature story, social media post, etc. *This question is required.

8. Please upload 1-5 photos from the event, if available.
Photos may be used for program promotion purposes.

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9. Did you connect with any new potential collaborators, sponsors, or other notable contacts during this trip? If yes, please mention names and affiliations, and also note any planned follow-up activities or meetings. *This question is required.

10. Personal Impact Testimonial - Thinking back to the justification you provided in the travel request, please describe how you benefited from attending this event.

You may provide up to three main benefits or outcomes that were meaningful to you. These might include new knowledge or skills, exposure to new ideas or practices, increased visibility for your work, progress on a project, greater confidence, clarification of next steps, unexpected opportunities, or other benefits.

We may use quotes from this testimonial for program promotion purposes. *This question is required.

11. Please confirm your understanding that the information provided in this form, including the event description, photos, and testimonial, may be shared publicly to promote the program. *This question is required.

12. Please feel free to share any other comments for staff only.
*These comments will not be shared with anyone except NAM and KEMRI staff.