Travel Fellowship Application

Professional Number:

First Name:

Last Name:

Preferred (non-employer) E-mail Address:

Phone Number:

Address:

Employer:

School/Site:

Contract Status:

Permanent

Probationary

Term

Description of Assignment:

Travel Destination:

Dates of Travel:

Event Attending:

B1: Description of travel (include PERSONAL agenda overview and area of focus)

B2: In detail, explain how this experience will enhance your professional growth.

Estimated Cost of Accommodations:

Estimated Cost of Meals:

Estimated Cost of Travel:

Other Estimated Costs:

TOTAL Estimated Costs:

Amount Applied For:

Amount Granted:

Amount Requested from Travel Fellowship (not to exceed $475):

Upon submitting this application you certify that the above information is correct, to the best of your knowledge.

Yes