Chapman Travel Grant Application - Crossing the Boundaries in Planetary Atmospheres: From Earth to
Exoplanets

Travel Grant Application

24 - 28 June2013 // Annapolis, Maryland, USA // Application Deadline: 25 February 2013

Question Title

Applicant Information

First Name

Middle Name

Last Name

Institution

Institution Address

Mailing Address (if different)

Institution Phone

Home Phone

E-Mail

Age

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Gender

Female

Male

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Country of Birth

Other (please specify)

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Citizenship

Other (please specify)

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Are you a student?

Yes

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If yes,

What degree are your working towards?

Expected graduation date

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If you are not a student:

Where did you receive your Ph.D?

When did you receive your Ph.D?

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Title and authors shown on the abstract of the paper you plan to present at this conference.

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Are you under any contractual or grant support from any government agency?

Yes

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If yes, what is the agency's name?

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Can you use these funds for travel to this conference?

Yes

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Have you requested any assistance for this conference from your institution?

Yes

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Estimated Travel-Related Expenses in U.S. Dollars
Oanda Currency Converter tool - http://www.oanda.com/currency/converter/

a) Estimated economic round-trip airfare between residence and destination

b) Estimated lodging, based on room rate + tax posted on website (you are encouraged to share a hotel room)

c) Other expenses (not including conference registration)

Description of other expenses

Total Estimated Travel Expenses (sum of A-C)

Amount of this total being requested from AGU

Amount of this total being provided by your institution or other source

Amount of this total being paid by you

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I certify that all information contained in this statement is true and correct to the best of my knowledge and belief.

Yes

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Electronic Signature

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If you are a student you must complete this section

Faculty Advisor Name

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If you are a student you must complete this section

Faculty Advisor Name

Faculty Advisor Position

Faculty Advisor Phone Number

Faculty Advisor E-Mail

Association with Student

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Advisor's brief statement on why they believe it is particularly beneficial for this student to attend this conference

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Is the student in good academic standing and actively engaged in research?

Yes

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Applicant Information

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Gender

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Country of Birth

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Citizenship

Question Title

Are you a student?

Question Title

If yes,

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If you are not a student:

Question Title

Title and authors shown on the abstract of the paper you plan to present at this conference.

Question Title

Are you under any contractual or grant support from any government agency?

Question Title

If yes, what is the agency's name?

Question Title

Can you use these funds for travel to this conference?

Question Title

Have you requested any assistance for this conference from your institution?

Question Title

Estimated Travel-Related Expenses in U.S. DollarsOanda Currency Converter tool - http://www.oanda.com/currency/converter/

Question Title

I certify that all information contained in this statement is true and correct to the best of my knowledge and belief.

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Electronic Signature

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If you are a student you must complete this section

Question Title

If you are a student you must complete this section

Question Title

Advisor's brief statement on why they believe it is particularly beneficial for this student to attend this conference

Question Title

Is the student in good academic standing and actively engaged in research?

Estimated Travel-Related Expenses in U.S. Dollars
Oanda Currency Converter tool - http://www.oanda.com/currency/converter/