Alaska INBRE Student Travel Award Application

Applicant Information

Last Name: / First Name: / Are you currently a UA student? / YES☐ NO ☐
University ID # / Phone: / ( ) / GPA:
Are you an International Student? / YES☐ / NO☐ / E-mail Address:
Faculty Mentor: / Departmental Travel Administrator & email address:
Faculty Mentor Email Address: / Department Phone: / ()
Have you received an INBRE travel award since August 1, 2016? Yes ☐ No ☐
If Yes… How much did you receive in travel support? $ And did you file a travel report? Yes ☐ No ☐
Is ANY of the travel listed in this application outside of the United States? Yes ☐No ☐
If Yes, will you be travelling to collect data, conduct research, collaborate with investigators at a foreign site anticipated to result in co-authorship, use facilities or instrumentation at a foreign site, or receive financial support or resources from a foreign entity?
Yes ☐No ☐ If Yes, please elaborate:

Travel Rule Reminder

All travel must be in accordance with UA Board of Regent Regulations . Travelers must use the
most economical and direct route of transportation available. Lodging and daily per diem rate allowances are based on GSA
. Travel Authorizations must befilled out correctly with the appropriate approving signatures for local,
out of state, and international destinations. Travel arrangements are the sole responsibility of the traveler and their major
or mentoring department. For additional information, visit the applicable campus travel website.

Conference Description OR Training Description

Event Background: / Provide web address if available. If not, enter description here. / Training Description:
Location & Address / Location & Address:
Date(s) of Event: / Date(s) of Event:
Are you presenting?
If yes, title of paper or abstract? / Objective:

Interest and Scope of Requested Travel

(150-200 words)- What is you interest in this conference, competition, or training? What benefits do you seek from attending? How does this experience pertain to your research studies and the specific aims of Alaska INBRE? Visit for information on the aims.

Budget and Certification Form

Itemize ALL your expenses (with brief justification): airfare/transportation, lodging, per diem, registration, materials, etc.
Source of Funds / Alaska INBRE $ / Other Expenses $ / Total Expected Expense $
Airfare
Mileage Reimbursement or car rental
Ground Transportation (taxi, bus, etc.)
Conference Registration (if applicable)
Per diem
Lodging
Other (parking, taxi, etc.)
TOTAL
Please list other pending or planned sources of funding for thistravel:
Comments? Other relevant information?
BY ELECTRONICALLY SUBMITTING THIS APPLICATION, I CERTIFY THAT THE PROVIDED INFORMATION IS ACCURATE. I CERTIFY THAT I WILL BE A REGISTERED STUDENT DURING THE TIME I WILL BE TRAVELING. I AGREE TO ABIDE BY THE CONDITIONS OF THIS APPLICATION AND THETRAVEL AWARD SOLICITATION AS DESCRIBED IN THE APPLICATION AND ON THE ALASKA INBRE WEBSITE. I UNDERSTAND AND ACCEPT THAT IF I VIOLATE THE CONDITIONS OF THIS AWARD, I CEASE TO BE ELIGIBLE IN THE FUTURE.
Student’s Name: / Date:
I AGREE TO SUPPORT THIS STUDENT’S TRAVEL REQUEST, AND ACCEPT FISCAL RESPONSIBIITY FOR THE AWARD FUNDS. AS PART OF THIS APPLICATION, I HAVE PROVIDED A LETTER OF SUPPORT.
Faculty’s Name: / Date: