Complete this form when your travel will expend or likely expend ASPR funding.
  • Conference Information

  • Date Format: MM slash DD slash YYYY
  • Date Format: MM slash DD slash YYYY
  • Estimated Expenses

  • $0.00
  • Conference Details and Justification

  • How will attendance at this conference enhance your facility and/or region's preparedness?
  • Attendees

  • NameTitleEmail 
  • Accepted file types: jpg, gif, png, docx, doc, pdf, xls.
  • Transmittal

    Upon submission, the Regional Hospital Coordinator will receive this form and review. From there, all requests must go to VHHA and to VDH. By submitting this form, the submitter certifies that these estimates have been arrive at through research and due diligence. Please be cognizant that approval of travel and attendance does not cover all expenses. Only expenses permitted by your regional coalition will be recovered. Responses to travel requests are typically returned within 7-10 business days.