Social Security Number:
Year in Program:
Have you received a GSA travel award in the past?
If so, when?
What other meetings have you attended within the past 12 months and are you planning to attend in the next 6 months?
Are you presenting your work at this meeting?
No presentation_____ Poster____ Talk____ Other (please describe below) _________
Please give the title(s) of your presentation:
Are there any travel scholarships to the meeting? If so, have you applied for these?
(please specify where you are staying and whether you will have a roommate)
(please specify if any meals or lodging is included in registration fee)
Other (attach details on separate sheet): $
Total Cost for Event: $
Support from mentor's grants: $
Program/Departmental support: $
Other (student out-of-pocket contributions, travel stipends, etc.): $
Amount Requested from GSA: $
Note that the terms of acceptance of a GSA travel award require that you give one hour of service to the GSA for each $100 accepted.
Please sign below that you understand these terms of acceptance and that you have filled out this application truthfully.
Signature: __________________________________ Date: __________________
Return to Travel Award Guidelines
Last modified: 1/11/00