Chapman Travel Grant Application - Silicic Magma Systems

Travel Grant Application

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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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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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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Are you receiving financial support to attend this conference?

Yes

If yes, what amount are you receiving?

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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

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

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Are you a student?

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If yes,

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If you are not a student:

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

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

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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?

Question Title

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

Question Title

Are you receiving financial support to attend this conference?

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

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/