THE GRADUATE SCHOOL

BINGHAMTON UNIVERSITY

GRADUATE SCHOOL – BINGHAMTON UNIVERSITY FOUNDATION

TRAVEL GRANT APPLICATION

** Applications must be typed/word processed**

Name: ______Social Security #: ______

Address: ______

(Street/Apt. #) (City) (State) (Zip code)

Graduate program: ______Date entered graduate program: ______

Telephone (daytime number): ______E-mail address : ______

MAIL CHECK TO ABOVE ADDRESS_____ MAIL CHECK TO DEPARTMENT ______

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Title of Dissertation: ______

______

Officially ABD (Y/N) _____ (i.e., department has submitted form for Admission to Doctoral Candidacy)

If Yes, Date Admission to Doctoral Candidacy Form Submitted ______(Mo./Yr.)

Travel Destination: ______

Dates of Travel: ______

Conference Title: ______

______

Organizing Agency: ______

Dates of Conference: ______

Type of Presentation (e.g. paper, poster, etc.): ______

Presentation Title (attach documentation): ______

______

Student' Name appears on conference program as presenter (Y/N) (attach documentation): ______

ÞÞÞÞOVERÞÞÞ

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Other Sources of Travel Funding: ______

Project Description: Provide a brief summary of your reasons for travel. Please attach appropriate documentation: for conference travel, a copy of the program or letter accepting your paper; for research, a prospectus and explanation of the need for and purpose of travel.

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Budget: Expenses can include billed travel or mileage reimbursement, conference registration, and lodging; meals are excluded.

Total Budget Requested: ______

(Limited to $500 per year for ABD students or

$250 per year for non-ABD students)

Breakdown:

(Proposed project must be in compliance with Graduate School and University policies, e.g., committee approval, human subject research review and approval, etc.)

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Signatures:

Applicant: ______Date: ______

Dissertation Advisor: ______

Or

Departmental: ______

(Chair or Director of Graduate Studies)

PLEASE SUBMIT COMPLETED FORM (typed/word processed) TO

THE OFFICE OF THE VICE PROVOST AND DEAN OF THE GRADUATE SCHOOL, AD- 127.

(Rev. 04/05)