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Faculty/Staff Travel Funding Request Form

Complete one application for each conference you wish to attend.

Date prepared:

Name:

E-mail:

Status:      If staff, faculty sponsor:

Conference/event:

Location:

Dates: from to

Will you be giving a presentation?

Title of your presentation or your role at the conference:

Please provide evidence of participation to:
  LaTia Whitmore
  2139 Observatory Lodge
  1402 Washington Heights
  Ann Arbor, MI 48109-2013.

Anticipated costs You are encouraged to be economical when planning your travel budget to make best use of limited travel funds. For example, take advantage of early registration fee savings, book your flight early, use double occupancy if possible, share taxis, etc.
		Details:
Transportation: $
Accommodations: $		please include name of hotel
Meals: $
Registration: $
Other: $
Total: $
~~~ Please put additional costs and details in "Notes" section below ~~~

Please list any other funding requests:
Amount requested from Rackham:	$
Amount covered by research grants or other sources:
Amount requested from Kinesiology:
Total:	$

Notes:

Faculty/Staff Travel Funding Request Form

Complete one application for each conference you wish to attend.

Anticipated costs