Instructions: This Form Should Be Completed, Signed by the Employee's Supervisor and Mailed

Graduate Student Application for Funding Provost Graduate Student Travel Award (PGSTA) and Graduate Activity Fee Allocation Committee (GAFAC) Return to 244 Ashe Building BIOGRAPHICAL INFORMATION S E Date Department C Name of Applicant School and Degree T I Telephone E-mail address O Student Number Number of graduate students involved N 1 WHAT ARE YOU APPLYING FOR? (please check one) S Provost Graduate Student Travel Award (PGSTA) E You must either be presenting at a conference or performing at an event to qualify.* C There is a $450 lifetime award limit. (complete section 2a and 3) Amount requested Department account to be credited T I Graduate Activity Fee Allocation Committee (GAFAC) $250 limit. Deadline: Fall –Nov 1, Spring – April 1 O (complete section 3) N Both (complete section 2a and section 3) 2 Proposed Dates Location S E Have you ever received funding from the PGSTA? (please check one) yes no C T If “yes” go to the next question. If “no” go to section 3. I If you ever received funding from the PGSTA, how much did you receive and when did you receive the funding? O N Amount Date 2a FUNDING CATEGORIES I am applying for the following category of funding (please check one): S E Conference Exhibition C circle one: presenting*, attending, organizing circle one: curating, exhibiting, attending T Performance Field Research I circle one: performing*, attending, staging O Equipment purchase Publication N 3 Event Filmmaking *Qualifies for the Provost Graduate Student Travel Award SIGNATURES AND APPROVALS I hearby certify that I have read and understood all three pages of the application and that the information provided is accurate and complete.

PRIMARY APPLICANT FACULTY ADVISOR

Signature Signature

Print Name Print Name APPROVALS (OFFICIAL USE ONLY) PGSTA signature Amount Awarded Date

GAFAC Application number approved denied tabled Amount Awarded Date