<p> 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.</p><p>PRIMARY APPLICANT FACULTY ADVISOR</p><p>Signature Signature</p><p>Print Name Print Name APPROVALS (OFFICIAL USE ONLY) PGSTA signature Amount Awarded Date </p><p>GAFAC Application number approved denied tabled Amount Awarded Date </p>