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Graduate Travel Awards Application

Cont’d next page Last modified: 4/5/2018 (1 of 2)

K ILL A M C E N T R E F O R A D V A N C E D S T U D IE S 2 -2 9 T R IF F O H A L L

Student ID Student Last Name, First Name

Department Degree Program Name of Supervisor Student Email Address

Travel Destination (City, Country) Departure Date Return Date

Purpose of Travel:

ConferenceTravel

Name of conference:

I have attached documentation from the conference organizers confirming my registration (outlining the cost for registration and what items are included…, and proof of payment)

Yes No

I have attached proof that my work has been accepted for presentation. Yes No

I am travelling for the following purpose: Paper presentation Poster presentation Panel discussion Exhibition of Work/Performance

ResearchTravel

Name of site/venue/workshop/institute attended:

I have attached documentation that from the organizers that confirms my participation in the trip

Yes No

I have attached confirmation that I have paid the associated expenses (e.g. registration fee) if any

Yes No

If the above is not available, I have attached a letter of support from my supervisor commenting on the significance of the travel for my research

Yes No

I am travelling for the following purpose: Data collection off-campus (field site/off-campus research station) Visit to archive/museum/exhibit/performance venue Workshop Summer Institute (Research purposes only)

Last modified: 4/5/2018 (2 of 2)

To be completed by department before submission to the FGSR:

Does the above-named applicant meet the following eligibility requirements? Completed min 2 terms of full-time course work in Course-Based Master’s program. Thesis-Based Master’s completed prelim course work/prerequisites, actively engaged in thesis research? Completed prelim course work/prerequisites and candidacy exam, actively engaged in thesis research in

Doctoral program.

I verify that the above-named student’s travel opportunity is appropriate and beneficial to the student’s program. Name of Department Chair/Supervisor

Signature (digital or hand-written) Date

Personal information on this form is collected under the authority of Section 33(c) of Alberta’s Freedom of Information and Protection of Privacy Act for authorized purposes including admission and registration; administration of records, scholarships and awards, student services; and university planning and research. Students’ personal information may be disclosed to academic and administrative units according to university policy, federal and provincial reporting requirements, data sharing agreements with student governance associations, and to contracted or public health care providers as required. For details on the use and disclosure of this information call the Faculty of Graduate Studies and Research at 780-492-3499 or see http://www.ipo.ualberta.ca/

Estimate of costs:

Amount (CAD$)

Description/Particulars

Conference/Workshop/Summer Institute Registration or Tuition

cost (if applicable)

$

Meals $

Airfare $

Ground Transportation $

Accommodation $

Other $

Total Estimated Expenses $

This section is mandatory: Indicate the values and source of any other funding you will receive (i.e., $500 from supervisor or $400 from department). Enter N/A if you will not receive any other funding:

Declaration: You must agree to the following declaration before submitting this form:

1. I agree to comply with University of Alberta regulations relating to scholarships and awards, and the Code of Student Behaviour and/or Code of Applicant Behaviour.

2. I certify that the information in this form is true and complete in all respects, and that I have withheld no information. 3. I authorize the University to verify any information provided as part of this award application. 4. I understand that misrepresentation, falsification of documents, or withholding of requested information regarding this

application are serious offences and may result in prosecution under the University's Code of Applicant Behaviour, Code of Student Behaviour and/or the Criminal Code of Canada.

I agree to the above Declaration *

Student’s Signature (digital or hand-written)

Date

*This form can be electronically signed, or signed and scanned, and emailed to grad.awards@ualberta.ca from your UAlberta email account.