Executive Mentor Program Travel Grant Application

Executive Mentor Program Travel Grant Application

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The Executive Mentor Program will reimburse a student up to $750.00 in travel expenses (airfare, mileage, ground transportation, and/or lodging) to visit their executive mentor. This opportunity for travel reimbursement applies only to students who have an executive mentor residing 250 or more miles outside Manhattan, KS and not in the student’s hometown.

Contact Information

Name
WID
Street Address (permanent)
City, State ZIP
Phone
E-Mail Address

Travel Plans

Destination (City, State)
Dates of proposed travel

Travel Expenses

For which expenses are you applying to be reimbursed?

Airfare
Mileage to/from destination ($0.30/mile, in lieu of airfare - when driving is more cost/time efficient than flying)
Ground transportation from airport to hotel/executive mentor’s home/office (i.e., taxi, bus, train)
Lodging
Estimated Expenses:
Airfare / $
Mileage / # miles x $0.30/mile = $
Ground transportation / $
Lodging / # nights x $ per night = $
Total expenses / $
Please attach supporting information, such as sample flight itinerary and cost info from airline website, map of mileage to/from destination, and/or estimated cost from hotel website.

Executive Mentor Contact Information

Name
Phone
E-Mail Address
Please have your mentor provide a letter of support
(attached to this application or sent via email to Emily Brueseke at )
indicating that s/he is aware of and in support of your visit.

Itinerary

Please describe the activities that you and your executive mentor have planned for your visit.

Goals of Visit

Please list your goals for the visit.

Agreement and Signature

By submitting this application, I affirm that the information I have providedis accurate and complete to the best of my knowledge. I understand that submitting an application is no guarantee that I will be awarded travel money to visit my mentor. If I am awarded a travel grant, I understand that the money will be provided to me in the form of a scholarship that will be deposited into my student account after travel has been completed.

Name (printed)
Signature
Date

Application Review Process

Applications will be reviewed on an on-going basis throughout the academic year and travel grants will be awarded until all money for the year has been distributed.

Completed applications should be submitted to Emily Brueseke, Director of the Executive Mentor Program (College Court Building, enter door B, downstairs to suite 41).

Upon receipt of your complete application, you can expect to receive a response within five business days with instructions on how to proceed if your request is approved. Please be aware that approved travel will be reimbursed in the form of a scholarship that will be deposited into your student account. Student travel scholarships will be awarded AFTER travel has taken place and are contingent upon submission of all associated travel receipts to the Executive Mentor Program. Students will also be asked to provide a brief statement about how they benefitted from the opportunity to visit their executive mentor.

If you have questions, please contact Emily Brueseke (785-532-3661, ). Thank you for your application!