Request for Faculty Travel Grant (Version 09-15-06)

 

First Request ____      Second Request ____    

(Funds must be used during this fiscal year (i.e., before June 30))

 

Applicant’s name: _______________________________________________________

 

Division (circle one):   I      II      III      IV

 

Address for award notification (if other than campus address):

_______________________________________________________________________

_______________________________________________________________________

 

Event:

_______________________________________________________________________

_______________________________________________________________________

 

Location: _______________________________________________________________

 

Dates: ________________________________________ Number of Days: __________

                                                              

Active Participation (choose one):	___ Yes ($1,000 maximum award)
	___ No ($500 maximum award)

 

Description of Participation:

_______________________________________________________________________ _______________________________________________________________________

 

Budget Summary

Transportation:	Airfare	________
	Train	________
	Automobile  ____ miles @$0.485 per mile =	________
	Taxi/Parking/Limo	________
Hotel:	___ days @  $ _______ per day =	________
Meals:	___ days @  $ _______ per day =	________
Registration Fees:		________
Other expenses:	(please itemize on another page)	________
Total:		________

 

Signature: _________________________________________ Date: _______________