DIMACS Special Focus on Computational and Mathematical Epidemiology and

Special Focus on Communication Security and Information Privacy

DIMACS Short Course: Statistical De-identification of Confidential Health Data with Application to the
HIPAA Privacy Regulations

APPLICATION FOR FINANCIAL SUPPORT

Limited financial support is expected to be available. How much we offer will depend on the number of applications received and might have to be limited to waiver of registration fees for some of the applicants.

Your Name:

Your organization

Department:

Street Address:

City:

State:

Zip Code:

Phone:

Fax:

E-mail:

Web page URL:

I would like to apply for:

__ Waiver of registration fee

__ Local expenses (hotel, meals) in the amount of ____

__ Transportation costs in the amount of ____

Please explain in a few sentences why you need the support, what sources of support you might have, and how you would expect to benefit from the Tutorial.

* Please email this application to the Short Course: Statistical De-identification of Confidential Health Data with Application to the HIPAA Privacy Regulations Program Administrator at: workshop-coordinator@dimacs.rutgers.edu