SurveyMonkey Powered Online Survey

Exit this survey

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

Question Title

Gender

Female

Male

Question Title

Country of Birth

Other (please specify)

Question Title

Citizenship

Other (please specify)

Question Title

Are you a student?

Yes

Question Title

If yes,

What degree are your working towards?

Expected graduation date

Question Title

If you are not a student:

Where did you receive your Ph.D?

When did you receive your Ph.D?

Question Title

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.

Question Title

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

Yes

Question Title

If yes, what is the agency's name?

Question Title

Can you use these funds for travel to this conference?

Yes

Question Title

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

Yes

Question Title

Are you receiving financial support to attend this conference?

Yes

If yes, what amount are you receiving?

Question Title

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

Question Title

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

Yes

Question Title

Electronic Signature

Question Title

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

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?

Yes

Question Title

Applicant Information

Question Title

Gender

Question Title

Country of Birth

Question Title

Citizenship

Question Title

Are you a student?

Question Title

If yes,

Question Title

If you are not a student:

Question Title

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

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

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.

Question Title

Electronic Signature

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/