Application

Name: College Email Address: Box Number: Overall GPA: Gender:	Date: Phone: Class Year: Major:
Advisor Name: Name of Conference: Project / Presentation Title:	Advisor E-Mail: Location of Conference: Dates of Conference: Format of Presentation: Other:
Reason for Research: Class: Other:
Have you submitted an abstract?	Has your abstract been accepted? If no, when do you expect it to be?

Brief Description of Presentation:

Please itemize your proposed travel costs:

Travel:
Cost:
Hotel:
Cost:
Conference Fees:
Cost:
Misc Cost(s):
Cost:
Cost:
Cost:
Total Requested (not to exceed $450)

By submiting this form, I acknowledge that if I receive funding, I voluntarily elect to attend the Conference named above. I specifically release the College from any and all claims of liability of any sort or causes of action on my part.

(Type your full name)

Application

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