Last Name: First Name:
E-Mail: Date of Request :
Participant Status
Presenter Panelist Moderator Job Market Attendee
Paper Title
Name of Meeting, conference, institute, event, etc. :
Location:
Starting Day/Month/Year: Ending Day/Month/Year:
Has this event been confirmed?: Yes No If NO, when is confirmation expected?:
Please explain why this activity merits department support. What consequences will result from this activity? How are they crucial to your research and/or teaching? Finally, if you are seeking funding for something other than the regular meeting of a major international or national association, please indicate the significance of the event:
1. Travel
2. Lodging
3. Per Diem Expenses
4. Other (specify)
Total Amount of Request:
Have you applied for other internal or external funding for any part of this travel? Yes No If you answered yes to the above question, specify source and amount:
Source Amount
If you answered no to the above question, please explain:
Will you recieve funds from any other source for all or part of your expense? (Examples include Host Instituions or organizations, grants, contracts, fellowships.) Yes No If you answered yes to the above question, specify source and amount:
Comments:
Please click on the following guidelines for travel arrangements. If you have further questions regarding your travel, please contact Staci Kelly.
