UIC GSC Travel Award Application

Today's date	11/23/2009
First Name	Last Name
UIN
Address:
Street
City	State ZIP
Phone
Email
Confirm Email
International Student?
Degree Program
Degree Sought
Advisor:
First Name	Last Name
Department Head or DGS:
First Name	Last Name
Conference Name
Conference Location
Conference Start Date
Conference End Date
Presentation Title
Presentation Authors
Estimated Travel Budget:
Transportation	$
Lodging	$
Food	$
Registration Fees	$
Other Expenses	$
Other Expenses Description:

Estimated other sources of funding:
Amount	$
Please describe your other sources of funding:

Amount Requested (up to $300)	$

Your GSC departmental representatives are your primary sources of information. Find your representative here. Make sure you contact them first. For any remaining questions or comments, please contact the GSC Travel Award Committee.

Questions? Comments?