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Presenter Awards Application

PRESENTER AWARD APPLICATION
Print this page (do not copy/paste) and complete the application.   Altered or incomplete applications WILL NOT be considered.
Submit applications to: Susana Sylvester, Graduate College MC 192, 612 University Hall

STUDENT: ATTACH ABSTRACT OF WORK PRESENTED AND OFFICIAL LETTER OF INVITATION

Name_______________________________________________ UIN _______________________

Date ________________ Program________________________ Program Mail Code (MC) ______

E-Mail__________________________ Daytime Telephone______________________

Conference Name________________________________________________________

Conference Location_______________________  Conference Dates _________________________

Mode of Travel (if car, list mileage outside the Chicago metro area) ________________

Budget:      
Transportation_________________________

Hotel________________________________

Registration___________________________

Other (specify) _________________________

Total_________________________________

Certification by Faculty
The above named student will be presenting the work outlined in the attached abstract. The meeting at which the student is presenting is a significant meeting in the student’s field, and this travel is endorsed by the program.

________________________________            _________________
Advisor, Department Head, or DGS                        Date

OPTIONAL: Matching Funds (required for students requesting more than $100 from the Graduate College): 

I, (department head or faculty sponsor)____________________________, agree to provide matching funds in the amount of $___________ to support the Presenter’s Award should s/he be granted the Award.

______________________________          _________________
Signature                                                               Date