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

Name of Conference:  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

		Day 1	Day 2	Day 3	Day 4	Total
Travel	Round-Trip Fare or
	By car (.550 cents/mile)
	Total travel expenses
Daily	Breakfast
Subsidy	Lunch
	Dinner
	Room
Fees	Registration
				TOTAL REQUEST

ID Number:

Department:

Name:	Office Address:
Signature:	Date:

Send printed 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 and must include original receipts. Please see http://www.smith.edu/controller/BANNERXtender.doc for guidelines on submitting receipts. TOTAL REQUEST $ Press the DISPLAY button, and your information will be presented to you in a new format for you to print. Your information will not be transmitted electronically.