Please attach brochure or any other relevant information pertaining to this conference/trip.

Student Conference Travel Funding

Date

Name

Uniqname

Student ID #

Conference Title

Date(s) of Conference

Requested Amount

Student Contribution

Location of Conference

Cost of: Conference

Cost of: Travel

Cost of: Lodging

List all funding you plan to receive to offset the cost of this trip

Are you participating in a poster or any type of presentation?

Yes

Rationale for attendance:

Sessions of Interest

Personal Goal for Conference

How will this conference benefit the School of Nursing

Additional Comments

Please print this form and submit to OSA with a copy of the conference or course brochure.

The application is due 30 days prior to the conference.

NOTE: If funding is granted, a written summary of the conference or a brown bag session is required within 30 days of the conference date

FOR OFFICE USE ONLY

Amount granted

Notes (Date report submitted or Date of brown bag)