FACULTY SENATE

CONVOCATIONS COMMITTEE APPLICATION FORM FOR FUNDING

PLEASE PRINT OUT AND COMPLETE THIS FORM. SEND IT, ALONG WITH ADDITIONAL SUPPORTING INFORMATION TO: Convocations Committee, Office of the Faculty Senate, 420 University Terrace, Suite 202, City Campus (0684)

INFORMATION ON SPEAKER

Speaker's Name, Title, and Field:

 

Speaker's Institution and Address:

 

Give a brief summary of the speaker's credential and indicate those achievements most pertinent to the proposed program. You must attach a detailed vita and additional information to this application form.

 

 

PROPOSED SCHEDULE

Date(s) of Visit:

 

Public lectures or meetings. Include topic/title, place, date, and time. Will admission be charged?

 

 

Classes: include course number, date, and time.

 

Other planned involvements. (Informal conferences, consultations on research, meetings with faculty and/or student groups, etc.) Identify the groups and/or individuals involved and the nature of the activity.

FUNDING INFORMATION

Travel required from:

Travel expenses: $

Honorarium: $

Promotion/Publicity Expenses: $

Local Expenses (food, lodging):

Funding Amounts Requested:

From Convocations Committee: $

From Department or Other: $

APPLICATION SUBMITTED BY:

Signature of Department Chair:

 

FOR CONVOCATIONS COMMITTEE USE ONLY

Date Application Received:

Amount Approved:

Signature of Committee Chair: