Chapman Conference Travel Grant Application - Evolution of the Monsoon, Biosphere and Mountain Building in Cenozoic Asia

Travel Grant Application

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* 1. 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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* 2. Gender

Female

Male

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* 3. Country of Birth

Other (please specify)

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* 4. Citizenship

Other (please specify)

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* 5. Are you a student?

Yes

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* 6. If yes,

What degree are your working towards?

Expected graduation date

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* 7. If you are not a student:

Where did you receive your Ph.D?

When did you receive your Ph.D?

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* 8. Are you submitting an abstract (priority will be given to applicants submitting an abstract)?

Yes

If yes, provide the title and authors on the abstracts you are submitting.

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

Yes

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* 10. If yes, what is the agency's name?

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* 11. Can you use these funds for travel to this conference?

Yes

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

Yes

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* 13. Are you receiving financial support to attend this conference?

Yes

If yes, what amount are you receiving?

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

a) Estimated economy 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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* 15. 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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* 16. Electronic Signature

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

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

Yes

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* 1. Applicant Information

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* 2. Gender

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* 3. Country of Birth

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* 4. Citizenship

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* 5. Are you a student?

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* 6. If yes,

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* 7. If you are not a student:

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* 8. Are you submitting an abstract (priority will be given to applicants submitting an abstract)?

Question Title

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

Question Title

* 10. If yes, what is the agency's name?

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* 11. Can you use these funds for travel to this conference?

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

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* 13. Are you receiving financial support to attend this conference?

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

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* 15. 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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* 16. Electronic Signature

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* 17. If you are a student you must complete this section

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

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

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