Undergraduate Research Committee
Student Travel Funding Application Form
First Name: Last Name:
Faculty Sponsor:
Campus address:
Campus Box:
Phone:
Email:
Conference:
Date:
Location:

1. Reasons for attending. For example, how will this further your academic goals?

2. Will you be giving a presentation or poster session? If so, please fill in the title of your talk or poster session and include a brief abstract in the spaces provided below. Send a copy of the conference acceptance letter to the chair of the Undergraduate Research Committee.

I will be giving a :

Title of Talk or Poster Session:

Abstract:

3. Expenses
 (please send relevant photocopies to the Academic Dean's Office).
(totals will be calculated when you submit the form) See below for non-travel related requests.

Registration Fee $
Lodging nights at $ /night

Meals
(suggested)

  • $5.00 breakfast
  • 10.00 lunch
  • 25.00 dinner

Note: we realize that
some places may be
more expensive than others.

 $
Travel by your own vehicle miles x $0.435 per mile
Parking and Tolls $
Airfare $
Other:
 (please specify)		 $ for

Non-Travel Requests:

Amount requested: $

Please give some details about your request in the space below: