First Name *

Last Name *

Email *

Phone *

Rank *
- Select Option Adjunct Faculty Assistant Professor Associate Professor Professor Not listed Please specify a value for Rank

Department *
- Select Department Academic & Student Support Academic Advising Athletics Academic Affairs Academic and Student Support Academic Records Academic Research Computing Academic Units ACCESS Administration Access Services Accessibility Resources Accounting Accounting Office ACES Admin - Spicer Admin Processing Admissions & Recruitment Office Admissions - Diverse Populations Admissions Administration and Operations Admissions Processors Admissions Recruiting Advertising Writing Alternative, Prior, and Workforce Learning Alumni Relations Office Annual Giving and Digital Strategy Anthropology Adjuncts Anthropology Staff Anthropology Visiting Faculty Aramark Food Company Employees Area and Global Studies Adjuncts Area and Global Studies Visiting Faculty Army ROTC Art Museum Art Museum Project Management Assessment and Future Planning Assistant Controller Office Assistant Director of Conference & Event Planning Assistant Director of Student Account Services Office Assoc Director - Scholarships Associate VP for University Development Office Asst Dean - COC Asst Dir Campus Recreation Asst Director - Scholarships Athletic Communications Athletic Creative Services Athletic Facility/Event Op Athletics Athletics & Recreation Facilities Athletics Adjuncts Athletics Event Operations Athletics Game/Event Athletics Health Care Athletics Operations Audio Operations Auxiliary Services AWRI Distinguished Research Fellow AWRI Ecological Research AWRI Education Specialist AWRI Research Assistant AWRI Staff AWRI Vessel/Fleet Operations Staff Baseball Basketball Men Basketball Women Battle Creek Outreach Battle Creek Outreach Center Battle Creek Outreach Office BCOIS Advising Center BCOIS Area and Global Studies BCOIS Assoc Dean BCOIS Dean and Administration BCOIS Environmental Studies BCOIS Frederik Meijer Honors College BCOIS General Education BCOIS Integrative Studies BCOIS Integrative Studies Visiting Faculty BCOIS Interdisciplinary Studies BCOIS Leadership and Professional Innovation BCOIS Meijer Center Writing/MI Authors BCOIS Meijer Honors College Staff BCOIS Office of Sustainability Practices BCOIS Women, Gender, & Sexuality Studies Benefits Billing Services Billing services Biology Biology Adjunct Biology Laboratory Biology Staff Biology Visiting Faculty Biomedical Sciences Biomedical Sciences Adjuncts Biomedical Sciences Staff Biomedical Sciences Visiting Faculty Brooks College of Interdisciplinary Studies Budget and Resource Management Business & Finance Business and Entrepreneurship Career Center Business Comm Outreach Campus Recreation Career Center Office Coordinator CECI - Fredricks CECI Center for Educational Partnerships CECI Certification and Accreditation Data Base CECI Criminology, Criminal Justice, & Legal Studies CECI Educational Leadership and Counseling CECI Literacy, Educational Foundations, & Technology CECI Niu - Cooper CECI Police Academy CECI School of Community Leadership and Development CECI School of Social Work CECI Support CECI Support and Community Partnership CECI Teaching and Learning CECI Undergraduate Advising Center Cell and Molecular Biology Adjuncts Cell and Molecular Biology Laboratory Cell and Molecular Biology Staff Center for Adult and Continuing Studies Center for Educational Partnerships Center for Health and Well - being Center for Scholarly & Creative Excellence Center for Undergraduate Scholar Engagement Center for Women & Gender Equity Central - West Michigan Charter Schools Charter Schools Adjuncts Charter Schools Office Charter through College Programs Chemistry Adjuncts Chemistry Staff Chemistry Visiting Faculty Children's Enrichment Center CHP - Halling CHP Assistant Dean CHP Communication Sciences & Disorders CHP Kenyon CHP Occupational Science & Therapy CHP Physical Therapy & Athletic CHP Physical Therapy & Athletic Training CHP Physician Assistant Studies CHP School of Interdisciplinary Health CHP Scribe Academy CHP Student Services Civic Engagement and Assessment Civil Rights Spec CLAS Academic Advising CLAS Academic Advising Center CLAS Academic Advisiors CLAS Academic Advisors CLAS Annis Water Resources Institute CLAS Anthropology CLAS Autism Education Center CLAS Biology CLAS Biomedical Sciences CLAS Biomedical Sciences Lab CLAS Cell and Molecular Biology CLAS Center for Experiential Learning CLAS Chem CLAS Chemistry CLAS Classics CLAS Dean's Office CLAS English CLAS Facilities, Scheduling, Research, and Analytics CLAS Finance and Project Management CLAS Geography and Sustainable Planning CLAS Geology CLAS History CLAS Inclusive Excellence and Curriculum CLAS Mathematics CLAS Modern Languages and Literatures CLAS Movement Science CLAS Music, Theatre, and Dance CLAS Personnel, Hiring, and Planning CLAS Philosophy CLAS Physics CLAS Political Science CLAS Psychology CLAS Regional Math Science Center CLAS School of Communications CLAS Sociology CLAS Statistics CLAS Student Academic Services and Advising CLAS Tutoring CLAS Tutoring and Reading Center CLAS Visual & Media Arts CLAS VMA CLAS Writing Classics Staff Classics Visiting Faculty Client Services Client Services SBDC Climbing Center and Outdoor Adventures Clinical and Crisis Services Clinical Operations Club Sports and Business Operations COC Kalafut Collections and Digital Scholarship College Advancement College of Computing College of Computing Student Services College of Education and Community Innovation College of Health Professions College of Liberal Arts and Sciences College Programs Communication Sciences & Disorders Communication, Arts, and Education Career Center Communications and External Affairs Compliance and Systems Computing Office Conference & Event Planning Conference & Event Planning Client Services Conference Client Services Controller Corporate Education Corporate Partnerships Creative Director of Ucomm Creative Director of University Communications Office Creative Services Creative/Production Criminology, Criminal Justice, & Legal Studies Criminology, Criminal Justice, & Legal Studies Adjuncts Criminology, Criminal Justice, & Legal Studies Staff Cross Country/TNF Ctr Women/Gender Equity Curriculum and Degree Auditing Customer Service and Financial Literacy Dean of Students Dean of Students Office Department of Public Safety Dept Public Safety - Allendale Dept Public Safety - GR Deputy Chief I&E Officer Development Services Digital & Student - Driven Financial Empowerment Digital Strategy and Media Relations Digital Strategy Social Media Director of Treasury Office Diverse Populations Recruiting Division of Student Affairs Donor Communications Donor Relations Dorothy A Johnson Center for Philanthropy DPS Dispatch DPS Security DSA Creative Services Economics Department Economics Department Adjuncts & Students Economics Visiting Faculty Editorial Educational Leadership and Counseling Adjuncts Educational Leadership and Counseling Staff Educational Leadership and Counseling Visiting Faculty Educational Partnerships eLearning Technologies Employer Development Engagement and Dean of Students English Adjuncts English Staff English Visiting Faculty Enrollment Development and Educational Outreach Enterprise Applications Enterprise Architecture Enterprise Architecture - Network & Telecom Enterprise Architecture - Systems & Endpoint Esports European History Event Services Executive Assistant Pres Executive Associate External Engagement Fac Ser GR and Reg Ctrs Facilities Planning Facilities Services Facilities Services - Allendale Facilities Services - Custodial & Operations Facilities Services - GR and Regional Centers Facilities Services - Grounds Facilities Services - Maintenance Facilities Services - Operations Faculty Affairs and Academic Facilities Federal Systems and Processing Federal TRIO Programs Finance & Administration Finance and Grants Finance Department Finance Department Adjuncts Finance Department Visiting Faculty Financial Aid Compliance Financial Aid Office Financial Aid Processing Financial Assurance Fitness and Wellness Football Foundation Relations Fraternity and Sorority Life FTIAC, Transfer, and Adult Populations Gear Up Geography and Sustainable Planning Adjuncts Geography and Sustainable Planning Staff Geography and Sustainable Planning Visiting Faculty Geology Adjuncts Geology Staff Geology Visiting Faculty Golf Women Adjuncts GR Pew Service Counter Graduate Recruitment Graduate School Grand Valley State University GV NextEd Co - Lab GV NextEd Co - Lab Adjuncts GVSU Career Center GVSU Laker Store - Allendale GVSU Laker Store - GR Campuses Hauenstein Center Hauenstein Center for Presidential Studies Health Compliance History History Adjuncts History Staff Housing Housing and Residence Life Housing Facilities Housing Occupancy HR Communications HR Generalists HRIS HRL Occupancy HRSA ANEW Grant Project HRSA Grant - Funded Simulation Human Resources Human Resources Administration and Technology HVAC GR and Reg Ctrs ICA Administration ICA Baseball ICA Basketball Men ICA Basketball Women ICA Football ICA Lacrosse ICA Soccer ICA Softball ICA Softball Adjuncts ICA Swim ICA Tennis ICA Volleyball IDC Operations Inclusion and Equity & Title IX Information Security Information Technology Information Technology Operations Inorganic Chemistry Research Institutional Analysis Internal Operations Career Center IT IT Enterprise Services IT Enterprise Technologies IT Innovation & Research IT Services IT Services (Allendale) IT Services (Grand Rapids) Johnson Center Communication and Strategic Partnerships Johnson Center Community Data and Research Lab Johnson Center for Philanthropy Johnson Center Learning Services Johnson Center Operations K-12 Connect K-12 Operations Kaufman Interfaith Institute KBEI KCON Dean's Office KCON Family Health Center KCON Lewandowski KCON Nursing Graduate Programs & Research KCON Nursing Undergraduate Programs KCON Project Management KCON Simulation Center KCON Student Services KCON Wayfinding Study Kelly Family Sports Center Kirkhof College of Nursing Lab Operations Laboratory Services Laker Events and Communications Laker Store - Allendale Course Materials Laker Store - Allendale Operations Laker Store - Allendale Technology Laker Store - Allendale Warehouse Laker Store - GR Campuses LCD Learning & Development Liberal Arts Program Library Library Access Support Services Library Deans Office Library Temp PSS Literacy Educational Foundations, & Technology Staff Literacy, Educational Foundations, & Technology Literacy, Educational Foundations, & Technology Visiting Faculty Living Center Directors - North Living Center Directors - South Management Management Department Management Visiting Faculty Marketing Department Marketing Management Marketing Visiting Faculty Mathematics Adjuncts Mathematics Staff Mathematics Visiting Faculty Meadows Golf Club Meadows Maintenance - Student/Temp Media and Public Relations Meijer Honors College Meijer Honors College Visiting Faculty Men's Basketball Camp Men's Wrestling MI - SBDC MI SBDC Growth Team MI SBDC Technology Milton E. Ford LGBT Resource Center Modern Languages and Literatures Adjuncts Modern Languages and Literatures Staff Modern Languages and Literatures Visiting Faculty Molecular Monitoring Lab Movement Science Adjuncts Movement Science Staff Movement Science Visiting Faculty Multicultural Affairs Music, Theatre, and Dance Adjuncts Music, Theatre, and Dance Staff Music, Theatre, and Dance Visiting Faculty Muskegon Hub Muskegon Innovation Hub NCAA Compliance No Supervisor No Supervisor - PM Nursing Graduate Programs Occupational Safety and Health Adjuncts Occupational Science & Therapy Occupational Science & Therapy Visiting Faculty Ofc VP Inclusion/Equity Office of Certification and Accreditation Office of General Counsel Office of Research Compliance and Integrity Office of Sponsored Programs Office of Student Life Office of Sustainability Practices Office of the Employee Ombuds Office of the VP of Student Affairs OMNI Padnos College of Engineering Padnos International Center Parking Services Parking Services (Chris Swank) Patient Services Payroll PCE Advising Center PCE K12 Outreach PCE Occupational Safety and Health PCE Student Services People, Equity, and Culture Pew Faculty Teaching & Learning Center Philanthropy Philosophy Adjuncts Philosophy Staff Philosophy Visiting Faculty Physical Therapy & Athletic Training Physical Therapy & Athletic Training Adjuncts Physical Therapy & Athletic Training Visiting Faculty Physician Assistant Studies Adjuncts Physician Assistant Studies Visiting Faculty Physics Adjuncts Physics Staff Physics Visiting Faculty Police Academy Political Science Adjuncts Political Science Staff Political Science Visiting Faculty President's Office Staff Prevention and Community Education Prior Learning Procurement Services Professional Programs Program Coordinator Project Management Project Management Adjuncts Provost Executive Operations Provost Office Psychology Adjuncts Psychology Staff Psychology Visiting Faculty Rec Center and Pool Rec Center/Pool Records Recreation and Wellness Regional Math/Science Center Regional SBDC Registration Registration and Catalog Research Manager Residence Conduct and Care Residence Education Residence Engagement Residence Recruitment Retirees/Term - No Supers Revenue and Fan Development RMSC Project Manager SBDC Finance SBDC Marketing and Communication SBDC Tech Strategy SBDC Welch SCB - Smith Kelly SCB Budget and Administration SCB Center for Entrepreneurship and Innovation SCB Economics Department SCB Finance Department SCB Graduate Programs SCB Management Department SCB Marketing Department SCB MBA Programs Adjuncts SCB Mentorship SCB School of Accounting SCB Small Business Development Center SCB Student Academic Services SCB Undergraduate Programs SCB Van Andel Global Trade Center School of Accounting Adjuncts School of Accounting Visiting Faculty School of Communications Adjunct School of Communications Staff School of Communications Visiting Faculty School of Community Leadership and Development Adjunct School of Community Leadership and Development Staff School of Computing School of Computing Adjuncts/Visiting School of Engineering School of Engineering Adjuncts School of Engineering Visiting Faculty School of Interdisciplinary Health Adjuncts School of Social Work Adjuncts School of Social Work Staff School of Social Work Visiting Faculty School Oversight School Performance Seidman Advising Seidman College of Business Service Staff Simulation Center Simulation Center Coordinator Simulation Operations Soccer Social Justice Centers Sociology Adjunct Sociology Staff Sociology Visiting Faculty Spirit Program Sports Performance Statistics Adjuncts Statistics Staff Statistics Visiting Faculty Strategic Business Partners Strategic Initiative Strategy and Planning Student Account Services Student Affairs Budget and Finance Student Affairs, Equity, & Access Student Conduct Student Employment Office Student Engagement Student Records and Registration Student Success Student Success Programs Student Support & Belonging Student Support Belonging Student Wellness Studio Coordinator Study Abroad Study Abroad and International Partnerships Superior BCOIS Meijer Center Writing/MI Authors Systems and Discovery Talent Acquisition Talent Management Talent Management Manager Teaching and Learning Adjuncts Teaching and Learning Visiting Faculty Technology Commercialization Office Technology Supply The Meadows Golf Club The Meadows Maintenance The Meadows Maintenance Temp Hourly The Office of the President Thompson Scholars Title IX Office Total Rewards and Operations Center Transcripts Specialists Traverse City Regional Center TRIO College Programs TRIO Educational Talent Search TRIO Laker Educational Opportunity Ctr TRIO LEOC TRIO McNair TRIO Pre - College Programs TRIO SSS Classic TRIO Stu Support Serv STEM - HS TRIO Teacher Prep Student Support Services TRIO TPSSS TRIO Upward Bound - Detroit TRIO Upward Bound - Grand Rapids TRIO Upward Bound Math/Science - Detroit TRIO Upward Bound Math/Science - Wyoming TRIO Veterans Upward Bound UCC Training Undergraduate Program University Budgets University Communications University Communications - Photography University Communications - Video and Multimedia University Counseling Center University Development University Initiatives University Libraries University Libraries Adjuncts University Libraries Collections, Digital Strategy, and Strategic Organizational Development University Libraries Research and User Services University Libraries Resource Management & Administration University Marketing University Relations Upward Bound - Grand Rapids Vice President of Philanthropy Visitor Experience Visual & Media Arts Visual & Media Arts Adjuncts Visual & Media Arts Staff Visual & Media Arts Visiting Faculty Water Resources Institute Wayfinding Study Web App Development Web Development and Content Strategy Wellbeing and Inclusion WGVU WGVU - Business Admin WGVU - Educational Services WGVU - TV WGVU Content WGVU Development WGVU Educational Services WGVU Engineering WGVU Membership WGVU News and Public Affairs WGVU Promotions WGVU Television Production WKKF/BCPS/GVSU Partnership Grant Women's Wrestling Women, Gender, & Sexuality Studies Adjuncts Women, Gender, & Sexuality Studies Visiting Faculty Workforce Education WRI Assistant Writing Adjuncts Writing Visiting Faculty

Amount Requested *
Please enter a value less than or equal to 900.

Funding will contribute to the following college priorities (check all that apply) *
Dissemination of scholarly outcome
External funding possibilities
Accreditation requirements
Conference related to professional development goals
Benefits to students and classroom activities
Community engagement and GVSU visibility
Collaborative projects

Please Explain *

Prior to this request, have you exhausted your $900 unit/departmental faculty professional development fund? *
- Select Option Yes No

How much funding is currently available? *
Please enter a value greater than or equal to 0.

Have you allocated (or will you allocate) the remaining balance to this expense? *
- Select Option Yes No

Note: all available unit/departmental faculty professional development funds must be allocated towards this expense at the time of request.

Do you have conference fees? *
- Select Option Yes No

Conference Fees *
Please enter a value greater than or equal to 0.

Conference Fees - Method of Payment
- Select Option Personal Credit Card Departmental P-Card Not Paid Not listed Please specify a value for Conference Fees - Method of Payment

Are you presenting at a conference? *
- Select Option Yes No

Peer-reviewed? *
- Select Option Yes No

Presentation Title *

Name and Sponsor of Conference

Location

Start Date of Conference
- Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec - 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 - 2026 2025 2024 2023 2022 2021 2020 2019 2018 2017 2016 2015 2014 2013 2012 2011 2010 2009 2008 2007 2006 2005 2004 2003 2002 2001 2000 1999 1998 1997 1996 1995 1994 1993 1992 1991 1990 1989 1988 1987 1986 1985 1984 1983 1982 1981 1980 1979 1978 1977 1976 1975 1974 1973 1972 1971 1970 1969 1968 1967 1966 1965 1964 1963 1962 1961 1960 1959 1958 1957 1956 1955 1954 1953 1952 1951 1950 1949 1948 1947 1946 1945 1944 1943 1942 1941 1940 1939 1938 1937 1936 1935 1934 1933 1932 1931 1930 1929 1928 1927 1926 1925 1924 1923 1922 1921 1920 1919 1918 1917 1916 1915 1914 1913 1912 1911 1910 1909 1908 1907 1906 1905 1904 1903 1902 1901 1900

End Date of Conference
- Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec - 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 - 2026 2025 2024 2023 2022 2021 2020 2019 2018 2017 2016 2015 2014 2013 2012 2011 2010 2009 2008 2007 2006 2005 2004 2003 2002 2001 2000 1999 1998 1997 1996 1995 1994 1993 1992 1991 1990 1989 1988 1987 1986 1985 1984 1983 1982 1981 1980 1979 1978 1977 1976 1975 1974 1973 1972 1971 1970 1969 1968 1967 1966 1965 1964 1963 1962 1961 1960 1959 1958 1957 1956 1955 1954 1953 1952 1951 1950 1949 1948 1947 1946 1945 1944 1943 1942 1941 1940 1939 1938 1937 1936 1935 1934 1933 1932 1931 1930 1929 1928 1927 1926 1925 1924 1923 1922 1921 1920 1919 1918 1917 1916 1915 1914 1913 1912 1911 1910 1909 1908 1907 1906 1905 1904 1903 1902 1901 1900

Do you have travel expenses? *
- Select Option Yes No

Start Date of Travel
- Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec - 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 - 2026 2025 2024 2023 2022 2021 2020 2019 2018 2017 2016 2015 2014 2013 2012 2011 2010 2009 2008 2007 2006 2005 2004 2003 2002 2001 2000 1999 1998 1997 1996 1995 1994 1993 1992 1991 1990 1989 1988 1987 1986 1985 1984 1983 1982 1981 1980 1979 1978 1977 1976 1975 1974 1973 1972 1971 1970 1969 1968 1967 1966 1965 1964 1963 1962 1961 1960 1959 1958 1957 1956 1955 1954 1953 1952 1951 1950 1949 1948 1947 1946 1945 1944 1943 1942 1941 1940 1939 1938 1937 1936 1935 1934 1933 1932 1931 1930 1929 1928 1927 1926 1925 1924 1923 1922 1921 1920 1919 1918 1917 1916 1915 1914 1913 1912 1911 1910 1909 1908 1907 1906 1905 1904 1903 1902 1901 1900

End Date of Travel
- Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec - 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 - 2026 2025 2024 2023 2022 2021 2020 2019 2018 2017 2016 2015 2014 2013 2012 2011 2010 2009 2008 2007 2006 2005 2004 2003 2002 2001 2000 1999 1998 1997 1996 1995 1994 1993 1992 1991 1990 1989 1988 1987 1986 1985 1984 1983 1982 1981 1980 1979 1978 1977 1976 1975 1974 1973 1972 1971 1970 1969 1968 1967 1966 1965 1964 1963 1962 1961 1960 1959 1958 1957 1956 1955 1954 1953 1952 1951 1950 1949 1948 1947 1946 1945 1944 1943 1942 1941 1940 1939 1938 1937 1936 1935 1934 1933 1932 1931 1930 1929 1928 1927 1926 1925 1924 1923 1922 1921 1920 1919 1918 1917 1916 1915 1914 1913 1912 1911 1910 1909 1908 1907 1906 1905 1904 1903 1902 1901 1900

Do you have airfare expenses?
- Select Option Yes No

Airfare Amount
Please enter a value greater than or equal to 0.

Airfare Details

Airfare - Method of Payment
- Select Option Personal Credit Card Departmental P-Card Not Paid Not listed Please specify a value for Airfare - Method of Payment

Do you have lodging expenses?
- Select Option Yes No

Lodging Amount
Please enter a value greater than or equal to 0.

Lodging Details

Lodging - Method of Payment
- Select Option Personal Credit Card Departmental P-Card Not Paid Not listed Please specify a value for Lodging - Method of Payment

Do you have tolls, parking, and ground transportation expenses?
- Select Option Yes No

Amount - Tolls, Parking, Ground Transportation
Please enter a value greater than or equal to 0.

Tolls, Parking, Ground Transportation Details

Tolls, Parking, Ground Transportation - Method of Payment
- Select Option Personal Credit Card Departmental P-Card Not Paid Not listed Please specify a value for Tolls, Parking, Ground Transportation - Method of Payment

Do you have mileage expenses?
- Select Option Yes No

Mileage (roundtrip mileage x rate of 0.56) Amount
Please enter a value greater than or equal to 0.

Mileage Details

Do you have meal expenses?
- Select Option Yes No

Amount - Meals (Per Diem: Breakfast $14, Lunch $16, Dinner $29) *
Please enter a value greater than or equal to 0.

Meal Details

Total Travel Expenses *
Please enter a value greater than or equal to 0.

Have you applied for additional funding from other sources? *
- Select Option Yes No

Please explain

Have you applied for a CSCE Mini Grant?
- Select Option Yes No

Please explain

Was the CSCE Mini Grant funded?
- Select Option Yes No

Reason

CSCE Mini Grant Funded Amount *
Please enter a value greater than or equal to 0.

Have you applied for a CSCE Dissemination Grant?
- Select Option Yes No

Please explain

Was the CSCE Dissemination Grant funded?
- Select Option Yes No

Reason

CSCE Dissemination Grant Funded Amount *
Please enter a value greater than or equal to 0.

Have you applied for a FTLC Faculty Conference Travel Grant?
- Select Option Yes No

Please explain

Was the FTLC Faculty Conference Travel Grant funded?
- Select Option Yes No

Reason

FTLC Faculty Conference Travel Grant Funded Amount *
Please enter a value greater than or equal to 0.

Have you applied for additional funding from OURS, Academic and Professional Enrichment Grant? *
- Select Option Yes No N/A

Please explain

Was the OURS, Academic and Professional Enrichment Grant funded?
- Select Option Yes No

Reason

OURS, Academic and Professional Enrichment Grant Funded Amount *
Please enter a value greater than or equal to 0.

Have you applied for funding from another source? *
- Select Option Yes No N/A

Other Source of Funding

Additional Funding Source Amount *
Please enter a value greater than or equal to 0.

Total Additional Funding *
Please enter a value greater than or equal to 0.

Please provide sufficient justification for the amount requested and the way in which this request sufficiently contributes to your professional development below. *

Unit Head First Name *

Unit Head Last Name *

Unit Head Email *