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    • Application Form A:
    Off-campus Conferences and Workshops

    Today's Date:
    1/30/2025

    Last Name:

    First Name:

    Lewis ID:

    College:
     College of Aviation, Science and Technology
     College of Business
     College of Education and Social Sciences
     College of Humanities, Fine Arts and Communication
     College of Nursing and Health Sciences
     School of Graduate, Professional & Continuing Education
     
    Rank:
     Professor
     Associate Professor
     Assistant Professor
     Instructor
     
    Department:

    Faculty Status:
     Full Time
     Half Time
     
    Email:

    Office Phone:

    PROPOSAL

    Conference/Workshop Title:

    Please indicate your role in this conference. Mark all that apply to this conference:
    Attendee
    Session Presenter
    Poster Presenter
    Session Panelist
    Organization Officer
    Conference Committee member
    Invited Presenter
    Session Moderator

    Indicate the type of conference this represents for your discipline:
     International
     National
     Regional
     State
     Local
     
    Conference/Workshop Description: 

    Dates: date format) MM/DD/YYYY

    Location: (City, State and Country)

    What current University initiative does this conference/workshop support:
     Student Assessment
     Service Learning
     Online/Blended Learning
     International/Global Learning
     Mission Development
     Teaching Excellence
     Research
     
    Please explain the relevance of this conference/workshop to your professional development as a faculty member at 群p无码. 

    BUDGET

    Will any of your expenses for this conference be covered by the conference or organization that sponsors it? If yes, please enter the dollar amount)

    Conference Workshop Registration and Fees:

    Transportation Estimated Costs:

    Airfare/Train/Bus:

    Reimbursement restricted to coach/economy
    Taxis/Shuttle/Uber:

    Parking:

    Car Mileage:


    Lodging - Room Rate with Taxes:


    *Generally, overnight stays for Chicagoland conferences will not be funded. Please clarify reason for overnight stay in the Chicago area.

    SUBTOTAL:

     
    Other Funding:
    Will any of your expenses for this conference be covered by the conference or organization that sponsors it? If yes, please enter the dollar amount)

    TOTAL REQUESTED:

     Subtotal - Other Funding = TOTAL REQUESTED
      
    Have you submitted your Annual Faculty Report for the 2023-2024 Academic Year? (Faculty Development Funding is awarded to those faculty that have completed this report) 
     Yes
     No
     No, I am a new faculty member this academic year
     

    Security Password (Please type the word ):

    Note: Print this page for your records before submitting. Don't forget to submit your application after printing.


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