Before completing this form, please review the Guidelines in the Funding for Faculty Development booklet (Section I, pages 1-2).

Name of Conference/Sponsorsing Organization:  Location of Meeting:  Duration of Stay:  days         Inclusive Dates:  If you are receiving other funds for this trip, please specify:  Office held in the learned society or business committees:  Title of presentation:  Title of scholarly panel on which a presentation will be made:    Expenses Incurred Instructions: Please put a zero ( "0" - without the quotation marks ) in any box that is not filled with a number, below.

		Day 1	Day 2	Day 3	Day 4	Total
Travel	Round-Trip Fare or
	By car (.585 cents/mile) @
	Total travel expenses
Daily	Breakfast
Subsidy	Lunch
	Dinner
	Room
Fees	Registration
				TOTAL REQUEST

ID Number:

Department:

Name:	Office Address:
Signature:	Date:

After clicking the DISPLAY button, PRINT the form. Send form and receipts to: Assistant to the Associate Provost and Dean for Academic Development, College Hall 206 All professional meetings and conferences must be accompanied with Form 1; if they are attached to any other form, they will be returned. The requests must include original receipts, and they should be taped (no staples please!) to a separate piece of paper, with each receipt individually taped; please submit as many taped receipts on one piece of paper as space allows. Your information will not be transmitted electronically.       Once you have clicked the "Display" button, and your information from above is re-displayed (in a new format), print the form from your browser. Use the print button at the top of your browser screen, or go to "File" and choose "Print."