Student Travel Grant Application

Each student requesting a grant must fill out an individual application.

Group applications will not be accepted.

Information can be entered into this electronic PDF and printed. Signatures must be obtained once the form is complete.

Name: ______Student ID#: ______

Address: ______

______

E-mail: ______Phone #: ______

Are you a Citizen of the U.S. or Permanent Resident: □Yes □No

Please answer the following questions on a separate sheet and attach it to this application. All answers must be typed.

  1. Outline the details of your trip. Include the following:
  • Purpose
  • Location
  • Dates of travel
  • Dates of event
  • Mode of travel. Include an airfare estimate (i.e: printout from Orbitz, Travelocity, ect.)
  • Accommodations
  • Copy of itinerary
  1. Justify your need for financial support
  1. What do you anticipate learning from the event and how will you share these experiences with students at UAA?
  1. If traveling internationally, attach a letter of support from a staff or faculty member at UAA affiliated with the trip. If trip is academically related, letter should be from the Chair of the department or faculty member facilitating/supporting the trip.
  1. Submit completed applications and attachments to Liisa Morrison in USUAA Support Services, Student Union 206, by the deadlines listed below.

Deadlines

Applications are due on the following dates by 5:00 pm to Student Union 206:

Fall 2005:October 3

November 7

Spring 2006:February 6

March 6

Late applications will not be considered.

The USUAA Travel Board will notify the applicant of the outcome (approval or denial) within 10 days.

I understand and agree to the requirements and restrictions associated with the Student Travel Grant. I understand that while traveling, I represent the University of Alaska Anchorage and will adhere to the Student Code of Conduct.

______

Applicant’s name (printed)Applicant’s name (signature) Date

(Please turn application over)

Additional Sources of Funding

If you plan to seek funding support from additional areas, such as the ones listed below, please contact them directly. If you have already received funding approval, please complete the shaded area (s). If special circumstances are attached to your funding (i.e.: can only be used towards airfare, ect.), please indicate this exception.

Information can be entered into the electronic PDF. Signatures must be obtained once the form is complete.

□I will not be receiving any additional funding.

Club Council

$ ______has been authorized by the above mentioned source.

______

Club Council Chairperson (printed name)Club Council Chairperson (signature) Date

Recognized UAA Club or Organization

Name: ______

$ ______has been authorized by the above mentioned source.

______

President/Treasurer (printed name)President/Treasurer (signature) Date

______

Adviser (printed name)Adviser (signature) Date

Internal UAA Funding

□Student Travel Grant □Diversity Action Council
□UAA department: ______□ Office of Undergraduate and Research

$ ______has been authorized by the above mentioned source.

______

Budget authority (printed name)Budget authority (signature) Date

External funding (non-UAA)

Name: ______

$ ______has been authorized by the above mentioned source.

______

Contact person (printed name)Contact Person (signature) Date

______

Phone #E-mail