<p> MACK HEALTH SCIENCE UNDERGRADUATE RESEARCH CONFERENCE TRAVEL GRANT APPLICATION</p><p>PURPOSE name, please refer to http://weber.edu/DCHPResearch/default.html. The Mack Health Science Undergraduate Research travel grants are intended to COVER SHEET support outstanding students who have been accepted, or anticipate being accepted, to The cover sheet must be signed by the present their research findings at a student, the faculty mentor, and the faculty professional or scholarly conference. Grants mentor’s department chair. will be awarded to a maximum of $1,000 for travel-related expenses, as well as conference RESEARCH ABSTRACT registration. Submit the research abstract that was accepted by the conference, or will be ELIGIBILITY submitted to the conference. Abstracts must Eligible students must be nominated by a be written by the students, not the faculty. DCHP faculty. Students must be currently enrolled at WSU, or have graduated within PROJECT BUDGET & WORKSHEET one semester of the conference date. The Fill in the requested amounts and describe in research project must have been mentored by detail what the expenses in each category a DCHP faculty. entail. Indicate the total amount requested for this travel grant up to a maximum of $1,000. SUBMISSION CONFERENCE ACCEPTANCE Please submit an electronic copy (PDF file) with signatures of the application to the If the student has received a ‘letter of chairperson of the DCHP Undergraduate acceptance to present’ from the conference, it Research Committee (for the chairperson’s should be submitted with the application.” </p><p>Mack Health Science UR Conference Travel Grant Application 4-2015 Page 1 of 5 MACK HEALTH SCIENCE UNDERGRADUATE RESEARCH TRAVEL GRANT</p><p>COVER SHEET</p><p>DCHP faculty making this nomination: ______Date: ______</p><p>Amount Requested:______</p><p>1) Did the research project you worked on involve other students? Yes / No </p><p>(circle one)</p><p>2) If so, list their names: </p><p>______</p><p>______</p><p>3) Have other students from your project requested travel grant funding </p><p> from OUR (Office of Undergraduate Research)? Yes / No. If so, has it </p><p> been approved? Yes /No</p><p>4) If so, give their name: </p><p>______Student Information</p><p>______Student Name (last, first) Student ID#</p><p>______Phone Email</p><p>______Total Number of Credits Completed Anticipated Graduation (term/year*) (*funds may NOT be spent after graduation)</p><p>Project Information</p><p>______Project Title (10 words or less)</p><p>______</p><p>Mack Health Science UR Conference Travel Grant Application 4-2015 Page 2 of 5 Name of conference you wish to attend</p><p>______Dates, city and state of the conference</p><p>______Faculty Mentor Name (last, first) Mail Code</p><p>______College (Weber State is NOT the college) Department</p><p>______Student Signature Date</p><p>______Project Mentor Signature Date</p><p>______Campus Mail Phone Ext.</p><p>______Faculty Mentor Department Chair Date</p><p>______DCHP UR Committee Chair Date</p><p>Mack Health Science UR Conference Travel Grant Application 4-2015 Page 3 of 5 PROPOSAL ABSTRACT (Insert the abstract that you submitted to your conference below)</p><p>Mack Health Science UR Conference Travel Grant Application 4-2015 Page 4 of 5 BUDGET WORKSHEET</p><p>BUDGET ITEM DEPT. OR OUTSIDE PERSONAL PROPOSED GRAND TOTAL COLLEGE FUNDS AGENCY FUNDS FUNDS MACK FUNDS</p><p>Air Fare *</p><p>Hotel **</p><p>Registration Fee</p><p>Ground Transportation</p><p>GRAND TOTAL</p><p>Notes:</p><p>* Provide details on airfare (carrier):</p><p>** Provide details on hotel costs (per night, if you are sharing a room with another student). Be sure to ask for total charges including hotel tax and fees.</p><p>All university travel MUST be processed on a Purchasing Card. It is recommended that the faculty mentor use their P-card for the student expenses. P-cards will not be issued to students, unless they are traveling without a faculty.</p><p>You may not request money for overnight stays and per diem for in state conferences within 100 miles of Weber State University.</p><p>Mack Health Science UR Conference Travel Grant Application 4-2015 Page 5 of 5</p>