THE UNIVERSITY OF ILLINOIS SYSTEM - Travel Assistance Program Application

THE UNIVERSITY OF ILLINOIS SYSTEM - PRESIDENT'S RESEARCH TRAVEL ASSISTANCE PROGRAM

1. Name

First*

Middle

Last*

2. University Identification Number (UIN)*

3. Contact Information

Contact Information: Address Line 1 (street address or PO Box)*

Contact Information: Address Line 2 (apt, suite, unit, bldg, etc.)

Contact Information: City*

Contact Information: State*

Contact Information: Zip Code*

Email address*

4. University*

Urbana-Champaign
Chicago
Springfield
Other

5. College/Department*

6. Year in program*
First year Grad Student
Second year Grad Student
Third year Grad Student
Fourth year Grad Student
Fifth year Grad Student
Doctoral/Ph.D. Candidate
Other

7. Are you a University employee, e.g. TA, GA, RA?*

No
Yes

8. Conference

Name of Conference*

Conference location*

Date(s)*

Scope*

Local
Regional
National
International
Other

Organization/Association sponsoring the conference (spell out the name)*

9. Participation

Title of paper or presentation*

The presentation will be in the form of*
Poster
Individual Paper
Panel
Shared Paper
Other

Will you perform other duties at the conference?*
No
Yes

Will the presentation be distributed beyond the session attendees?*
No
Yes

10. Department support

When this application is submitted, your department head or faculty advisor will be asked to confirm their support for this application, and to confirm that the unit or department will be providing a minimum $200 contribution toward conference travel expenses. Please provide the contact information of the department head or faculty advisor with whom you've discussed this application, who will be contacted for confirmation of support.

Department or unit providing support*

Name of department head or faculty advisor*

Email of department head or faculty advisor*

Amount of support to be provided by your department or unit (min. $200)*

11. Anticipated conference expenses (round to nearest dollar)*

Travel Costs*

Lodging Expenses*

Registration Fees*

Other Expenses*

Total Expenses*

12. Abstract*

Type (or cut/paste) an abstract describing the work to be presented and its impact on the scholarship of representation. (7500 character limit)

13. Travel Plan*

Type (or cut/paste) a description of the travel plans and potential impact of the conference travel on you and your department or field of study. Include an itemization of the total support you are receiving to attend the conference. (5000 character limit)

14. Attach verification*

Attach verification that you have been accepted to present (e.g. conference program, invitation to present or other documentation). (Upload as PDF, Word, JPEG, etc. - Max file size: 4MB)

15. I understand that, should I receive this award, I must be in good academic standing when the conference and travel occurs.*

No
Yes

*Required