PsyDoc Program Student Travel Grant Application - Published
Name
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First Name
Last Name
Student ID
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Email
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example@example.com
Year in program
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1st
2nd
3rd
4th
5th
Date of application
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-
Month
-
Day
Year
Date
Address
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Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
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-
Area Code
Phone Number
Name of Conference
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SCHOLARSHIP SPECIFICS
1. Briefly describe your project and how it will contribute to your professional development.
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2. When and where will you use this scholarship (e.g., name, dates and location of the conference)?
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3. Provide the title of your poster or presentation.
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4. Where and in what forum do you plan on presenting your poster/presentation within the program (e.g., Research Lab on xx/xx/xxxx, during Grad Student Appreciation Week poster competition, etc.)
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GRANT REQUEST – MAXIMUM $700
(each budget item should include TOTAL eligible expenses for each category)
Budget
Cost
Conference registration (early bird rates preferred)
Travel
Hotel
Meals
Other (explain below)
Other explanation
Total requested - (if budget exceeds max allowable, enter budgeted amount)
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Note: Allocation of the funds for the Psy.D. Student Travel Grant will be made on a rolling basis by the Admissions and Academic Requirements Committee (AARC). Be aware that any monies that are not spent will need to be reimbursed by you. This grant is issued with the understanding that you will submit an expense report and a narrative report (description of your conference participation and how your professional goals were met) within thirty (30) days following the event). Please submit your report to Elisabeth Clements (elisabeth.clements@wheaton.edu). You are also expected to present the project in some forum within the program. If plans change and you do not use the funds to attend this event, it is understood that you will inform the AARC so the money can be used for other students’ travel.
TRAVEL GRANT HISTORY: (List your history of Student Travel Grants over the last three years. State Conference name, year attended and amount granted. {e.g., 2019 - CAPS - $650, 2018 - APA - $600})
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Student signature:
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Endorsing faculty email:
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example@example.com
Submit
Faculty endorsement signature: (By endorsing this student’s application you are confirming that you are the faculty mentor for this project and that you will be working closely with the student on this project)
Amount granted:
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Approved by:
Should be Empty: