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Travel_Award_application_form_29feb2012

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					                                                           THE UNIVERSITY OF MELBOURNE
                                                            MELBOURNE DENTAL SCHOOL
                                                        APPLICATION FOR TRAVEL AWARD– 2012
       This form should be completed in full and typewritten. The University’s privacy statement can be viewed at
                              http://www.unimelb.edu.au/unisec/privacy/studentinfo.html
BACKGROUND
The Research Committee of the Melbourne Dental School will award bi-annual travel grants from the 2012 Research Committee Budget and the Dental
Alumni Trust Fund to postgraduate and DDS students of the School to attend one (1) international and one (1) local (includes interstate and New Zealand)
conference. Travel grants are awarded on a competitive basis with PhD and Masters by Research students receiving priority for funding. Staff who are
also Research Higher Degree students are not eligible to receive this funding.

CONDITIONS OF GRANT
1. a) A total of up to $2,000 per student per candidature for international conference travel; and
   b) A total of up to $1,000 per student per candidature for local conference travel may be awarded on the basis of the following
         details being provided:
             Conference details including the name, location, dates etc (ie conference program)
             A copy of your proposed/accepted abstract (including your affiliation with the Melbourne Dental School and (if applicable) the CRC.
             Cost of conference registration fees
             Details of travel and accommodation fees
             How any shortfall will be paid for ie by Sponsor or own funds.
             Proof of attendance is submitted upon return of conference (ie receipts) together with a travel diary
             ‘Miscellaneous’ items and food costs will not be reimbursed
2. You must either present a poster or give an oral presentation at the conference.
3. For DDS students, only one student group member may attend the conference.
3. This travel award is paid as a reimbursement of expenses on presentation of paid receipts up to the value of the travel award. All other costs in
   excess of the travel award are the responsibility of the student. Cash will not be paid to the student.
4. Your supervisor signs your application for the Travel Award.
5. Upon approval of funding, students are responsible for obtaining their own travel insurance, which is to be submitted to the Research Administrator
   prior to departure.
6. Students fully-funded through the CRC for conference travel and attendance are not eligible to apply for School funding for the same purposes.
7. Funding will not be awarded retrospectively.

CLOSING DATES FOR 2012
Round 1 – Wednesday, 2 May 2012
Round 2 – Monday, 17 September 2012

SUBMISSION
Applications should be submitted to the Research Administrator in Room 4.408, 4th Floor. Ph 9341 1509. Electronic copies will not be accepted.

           PLEASE NOTE THAT THE FIELDS ON THIS FORM ARE LOCKED - USE THE TAB KEY TO MOVE BETWEEN FIELDS

Name of Applicant:

Email Address (University email address only):

Phone:

Name of Supervisor/s:
                                                                                          st
Enrolled Degree & year of Candidature (eg PhD, 1                                                 ,      year
year):


Conference type:                                                                               International Conference

                                                                                               Local Conference

Have you been fully funded for conference travel by the CRC?

      No                                       Yes (STOP! You are not eligible to complete this form)




M:\Research Committee\Postgrad Travel Award\2012\Travel Award application form 2012.doc                                                     Page 1 of 3
Conference Name:
(also advise website details and attach copy of conference program)

Conference Location:

Conference Dates:

I will be:                                                                                Title of poster / presentation:

      Giving an oral presentation

      Presenting a poster

Have you:                                                                                                                         Office Use Only
   Attached a copy of the proposed/accepted abstract
                                                                                                                            Checked by ……………..
      Included your affiliation with the Melbourne Dental School and, if
applicable, the CRC                                                                                                             Date ...……………



1. Budget (please compete budget on the following page).

Notes

            Itemise all expenses
            Miscellaneous expenses (eg food whilst on travel) will not be funded
            Attach supporting documents for each item requested, ie quotes for airfares, conference registration,
             accommodation fees etc

             Budget

                                    Item Requested                                                                     $




Total Cost

Amount Eligible to Request (see page 1)

Balance (difference between cost and eligible amount)




M:\Research Committee\Postgrad Travel Award\2012\Travel Award application form 2012.doc                                                Page 2 of 3
2. If your budget is over the prescribed amount, have you applied for any funds from another funding body to
   attend this conference?

      yes

      no


3. If yes, please provide details of funding applied for:
   a. Sponsor name:
   b. Amount requested:
   c. Additional information (optional):


4. Has the funding been approved? If yes, attach written confirmation of approval.

      yes

      no

Note: Failure to provide written confirmation will result in your application being rejected.

5. Supervisor Declaration:



I fully support the attendance of this student at the conference described above.


………………………………………………………………………………………………………………………………………………
…
Signature of Supervisor/s       Date


6. Student Declaration:



I acknowledge that I have complied with the above conditions.


………………………………………………………………………………………………………………………………………….……
…
Signature of Student            Date



Before submitting your application, please ensure you have attached all relevant supporting
documents:


            conference program and conference website details
            proposed abstract with affiliation to the Melbourne Dental School and (if applicable) the
             CRC
            quotes for airfares, accommodation, conference registration and workshop fees etc
            written approval of other funding obtained (if applicable)




M:\Research Committee\Postgrad Travel Award\2012\Travel Award application form 2012.doc            Page 3 of 3

				
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