• First Name*
• Last Name*
• Email Address
• Conference or Meeting*
• Title of Presentation*
• Conference Location*
• Conference Dates: From*MM/DD/YYYY
• Conference Dates: To*MM/DD/YYYY
• Travel Dates: From*MM/DD/YYYY
• Travel Dates: To*MM/DD/YYYY
• Faculty Member Attending Conference*
• Are You Attending as Part of a Group*YesNo
• If Yes, Please Provide the Names of the Other Particapants
• 1) Describe the benefit you expect from participation in the conference or meeting and explain the connection to mentoring provided by faculty member(s)?*
• 2) Describe the project/work you will be presenting.*
• 3) Describe the role you will have in presenting this project at the conference/meeting.*

• Expense Information

  Maximum award for a student presenter travel to conference or meeting is $1000. Please provide detail on your needs (registration, travel, lodging, meals, etc.) There is a $35 per day reimbursement for food. Receipts are required for reimbursements.

• Expense 1*
• Expense 1 Amount*$ . DollarsCents
• Expense 2
• Expense 2 Amount$ . DollarsCents
• Expense 3
• Expense 3 Amount$ . DollarsCents
• Expense 4
• Expense 4 Amount$ . DollarsCents
• Expense 5
• Expense 5 Amount$ . DollarsCents
• TOTAL*$ . DollarsCents

• Explanation of Funding Request

  Please provide an explanation of your funding request, including other sources of support and any plans you may you have to share expenses with other students who will be attending. There is a $3000 limit for student travel funds (presenter and non-presenter combined) to any one conference or meeting, so you are encouraged to coordinate your request with other students who may be attending and who will be seeking funding.

• Explanation*
• My Sponsoring Mentor has Reviewed this Application.*Yes
• Leave this field blank

This form has been closed. Thank you.

You have submitted this form the maximum number of times. Thank you.