<p> IEEE INDUSTRY APPLICATIONS SOCIETY</p><p>Chapters and Membership Development Department Student Conference Publication and Travel Support Program</p><p>STUDENT CONFERENCE PUBLICATION AND TRAVEL SUBSIDY APPLICATION FORM</p><p>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] </p><p>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$500 - One author per paper will be supported, exception requests a serious explanatory statement - Preferred conferences for supporting are the IAS sponsored conferences, http://ias.ieee.org/conference-schedule.html , especially student led technical conferences http://ias.ieee.org/chapters-membership.html >>What´s Going On? >>>The Club of the 6 and other conferences but within the scope of the field of activity of IAS.</p><p>APPLICANT’S Last name(s): First name(s): Email address: University / Occupation: Student status (undergraduate, graduated, PhD): SB IAS Chapter membership in: IAS Membership data: Member since: IEEE Membership No.: Membership grade: (Regular member, Undergraduate Student Member, Graduate Student Member, GOLD Member): IEEE function(s): Short description of IEEE volunteer activity:</p><p>CONFERENCE Name: Venue, date: Paper data, authors, title: Please provide the paper acceptance confirmation letter.</p><p>EXPENSES in US$:</p><p>Passport Visa Health insurance</p><p>THE INSTITUTE OF ELECTRICAL AND ELECTRONICS ENGINEERS, INC. Page 2 / 2 P. Magyar / Student Conference Subsidy Application Form</p><p>Registration fee Travel Accommodation Travel Total expenses</p><p>OTHER SUBSIDIES in US$:</p><p>Have you requested subsidy from your university / work place Yes, Amount received / No, Why not? Have you requested subsidy from the IEEE Voluntary Contribution Fund ? (search word VCF in the websites of the Regional Committees) Yes, Amount received / No, Why not? Have you requested subsidy from your IEEE Region / Section / Chapter / Student Branch ? Yes, Amount received / No, Why not? Subsidy received from other(s): Yes, Amount received (provide name of Institution) / No, Why not? Total subsidy received, US$:</p><p>BUDGET BALANCE in US$:</p><p>Difference of total expenses and total subsidy received Own contribution Requested amount from the IAS CMD Student Conference Publication and Travel Support Program</p><p>DATE of submitting the application:</p><p>APPROVAL: Proposal of the Student Conference Publication and Travel Support Program Co-Chair Approval/disapproval comment: Proposed amount, US$: 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:</p>