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FSAPP-Funding-Request

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					                Request for Funding to Support FSAPP Mentees

Name            ____________________________________________________________

Student ID#     ____________________________

Address         ____________________________________________________________

                ____________________________________________________________

Phone           ____________________________            Email _________________________________________

Please provide a description the professional development opportunity you want to participate in (not just
the title of the workshop or conference):




Please explain why you want to participate and how it will help you:




Amount requested for registration fee?          _______________

Amount requested for lodging?                   _______________

Location of lodging?                            _________________________________________________

Is this an approved conference lodging site? __________________

Who are you sharing a room with?                _________________________________________________

Total requesting?                               _______________

NOTE - Funding can only be used for conference registration fees and lodging. We prefer sharing rooms to cut down on
costs. Carpooling is also recommended but will be at the attendee’s own expense.
By signing this form, student acknowledges that s/he will pay the registration fee and expenses upfront and
reimbursement for those expenses will only be given after the event, provided adequate receipts are submitted within 1
week of returning from the event. Funding approval will be considered on a first come, first served basis.


______________________________________                  ________________
Student’s Signature                                     Date



______________________________________                  ________________
Account Approval – Debbie Gough                         Date
                                                                                                          Form updated 8/28/2012

				
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