VIMS G.S.A. Conference Fund Application

***Please include a short justification statement on a separate sheet***

NAME    ____________________________  GRADUATE STUDENT CLASSIFICATION: M.S. / Ph.D.

VIMS EXTENSION   x_________   E-MAIL  ___________________ DEPARTMENT    ______________

ADVISOR     ________________________________________________________________________

NAME OF CONFERENCE     ____________________________________________________________

LOCATION OF CONFERENCE     ________________________________________________________

ARE YOU A :
______ INVITED SPEAKER
______ ACCEPTED SPEAKER
______ RESEARCH INTEREST
______ OTHER ____________________________________________

ESTIMATED TOTAL EXPENSES:    _____________________

REGISTRATION $_________        (ATTACH COPY OF REGISTRATION FORM)

TRAVEL $____________    METHOD OF TRAVEL:   ________________________________________

LODGING $___________   ACCOMMODATIONS AT:    _____________________________________

LIST ALL OTHER SOURCES OF FUNDING:
 
$_______ FROM_____________ APPLIED TOWARDS______________________________

$_______ FROM_____________ APPLIED TOWARDS______________________________

$_______ FROM_____________ APPLIED TOWARDS______________________________

(LIST ADDITIONAL SOURCES ON A SEPARATE SHEET)

STUDENT SIGNATURE: ____________________________________ DATE:____________
Deadlines
September 29th for conferences from:  October 1st to January 31st
February 1st  for conferences from:  February 1st to April 30th
May 1st  for conferences from:   May 1st to September 30th