Hajim Instructional Conference and Travel Grant Request Form
This is an application for the HICAT fund to support faculty and staff attending conferences related to engineering and computer science education. Please contact Paul Funkenbusch at paul.funkenbusch@rochester.edu if you have questions.
Name
*
First Name
Last Name
Email
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Department
*
Appointment
*
Faculty
Staff
Conference Information
Name of Conference
Location of Conference
Conference Start Date
-
Month
-
Day
Year
Date
Conference End Date
-
Month
-
Day
Year
Date
Estimated Budget
*
Briefly describe how attending this conference will contribute to your professional development and/or your engineering curriculum:
*
Will you be presenting a paper, poster, or other presentation at this conference?
Yes
No
Please give a brief description of the paper/presentation below:
Please upload your paper/presentation here:
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Other Support
Is any of the work being presented supported by an external grant?
Yes
No
If yes, please give details here:
Will your department or program help support your conference participation?
Yes
No
If yes, what is their contribution?
Is there any additional information you would like to provide?
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