Application for CHS Undergrad Research Funding for Student Travel and Meeting Registration

Student ID # *

E-mail Address *

Student’s Department and College *

Major *

Campus Address *

Expected year of graduation *

Enrollment Status (Select one) *

Gender (Select one) *

Demographics (Please select ALL that apply. Only used for record keeping) *

Meeting Name and Location *

Meeting Date *

Presentation Title *

Contributing Authors *

College/Department where your research experience will take place *

Funding be used for *

Requested Amount *

Is your mentor providing any funding to help defray your travel & meeting expenses? *

Yes

No

Please indicate how much support is being provided by your mentor and from what source *

Provide a description of how the requested funds will be used *

Research