Society for Community Research & Action
2013 Biennial Conference in Miami
International Travel Support
Application Form
Please send your complete application to Dr. Ikeda, Chair of the International Committee, via e-mail () by May/11ｔｈ. MS-Word or PDF file is accepted.
Applicant’s Personal Information
1. First (Given) Name / 2. Last (Family) Name3. Contact Address
4. Country of Residence / 5. Nationality
6. E-mail Address
7. Institution (Affiliation)
8. Membership Type
(Put “X” one) / [ ] US (Full) Member
[ ] Student Member
[ ] International Member
[ ] Senior Member
[ ] Not Currently a Member
9. Job Status
(Put “X” one) / [ ] Full-time employee
[ ] Part-time employee
[ ] Not working at all
Participation at the 2013 SCRA Biennial
10. Have you ever attended past SCRA biennials? / [ ] Yes. / [ ] No.11. Please write all the titles and session types of your accepted presentation.
12. Please copy & paste your accepted presentation abstract. If you are accepted for multiple sessions, please write about your most primary presentation.
13. Your role / [ ] First author (presenter) of a session/presentation.
[ ] Facilitator of asession presentation.
[ ] Non-first author (presenter) ofa session/presentation.
[ ] Others -> Specify:
Travel Information
14. Departing City & Country
15. Please provide information regarding your expected travel expenses, excluding food and incidental expenses.
Item / Expected cost (US$) / Remarks or explanations
Airfare
Hotel
Visa-related expenses
Other
TOTAL
16. Do you have any other source of funding which covers your travel costs?
[ ] Yes.
[ ] No.
[ ] I applied, but the review process are still ongoing.
16. Please describe your special needs for the funding support. (No more than 300 words)
Optional: the answer will not be reviewed for selection.
Please briefly describe what you expect from the International Committee of SCRA.
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