P. Magyar / Student Conference Subsidy Application Form

IEEE INDUSTRY APPLICATIONS SOCIETY

Chapters and Membership Development Department Student Conference Publication and Travel Support Program

STUDENT CONFERENCE PUBLICATION AND TRAVEL SUBSIDY APPLICATION FORM

The fully completed form should be forwarded to Mohit Setia, IAS CMD Travel Awards Committee, Conference Publication and Travel Program Subcommittee Chair, [email protected] and concurrently in copy to Peter Magyar, CMD Chair, [email protected]

Main conditions for providing a subsidy: - IAS membership, student grade and SB IAS Chapter members and active volunteers are preferred - Submitted and approved paper - The IAS support is limited to US$500 - One author per paper will be supported, exception requests a serious explanatory statement - Preferred conferences for supporting are the IAS sponsored conferences, http://ias.ieee.org/conference-schedule.html , especially student led technical conferences http://ias.ieee.org/chapters-membership.html >>What´s Going On? >>>The Club of the 6 and other conferences but within the scope of the field of activity of IAS.

APPLICANT’S Last name(s): First name(s): Email address: University / Occupation: Student status (undergraduate, graduated, PhD): SB IAS Chapter membership in: IAS Membership data: Member since: IEEE Membership No.: Membership grade: (Regular member, Undergraduate Student Member, Graduate Student Member, GOLD Member): IEEE function(s): Short description of IEEE volunteer activity:

CONFERENCE Name: Venue, date: Paper data, authors, title: Please provide the paper acceptance confirmation letter.

EXPENSES in US$:

Passport Visa Health insurance

THE INSTITUTE OF ELECTRICAL AND ELECTRONICS ENGINEERS, INC. Page 2 / 2 P. Magyar / Student Conference Subsidy Application Form

Registration fee Travel Accommodation Travel Total expenses

OTHER SUBSIDIES in US$:

Have you requested subsidy from your university / work place Yes, Amount received / No, Why not? Have you requested subsidy from the IEEE Voluntary Contribution Fund ? (search word VCF in the websites of the Regional Committees) Yes, Amount received / No, Why not? Have you requested subsidy from your IEEE Region / Section / Chapter / Student Branch ? Yes, Amount received / No, Why not? Subsidy received from other(s): Yes, Amount received (provide name of Institution) / No, Why not? Total subsidy received, US$:

BUDGET BALANCE in US$:

Difference of total expenses and total subsidy received Own contribution Requested amount from the IAS CMD Student Conference Publication and Travel Support Program

DATE of submitting the application:

APPROVAL: Proposal of the Student Conference Publication and Travel Support Program Co-Chair Approval/disapproval comment: Proposed amount, US$: The form forwarded to the CMD chair, date: Approval of the Chapters and Membership Development Department Chair Approved amount, US$: Applicant informed about the payment process, http://ias.ieee.org/chapters-membership/chapter-promotion-programs,-awards-and- contests.html>>>Financial Programs, date: The completed form received, date: The signed forms forwarded to the applicant, date: