Graduate Student Block Funding Request Form FY'23

Graduate Student Block Funding Request Form FY'23
Date

MonthDayYear
Date
Form Preparer's Name*
Form Preparer's Email*
example@example.com
Dept/Graduate Program*
Student's Name

First NameMiddle NameLast Name
Student's Email*
example@example.com
UKID#*
Select Type*

MSPhD
Graduate Advisor Name*
Graduate Advisor Email*
example@example.com
DGS Name*
Note: The DGS will receive an email from JOTFORM confirming that they are requesting the funds. He/She will need to APPROVE when they receive the email. This can be done from a computer, ipad, or iphone.

The Graduate Advisor's name is for informational purposes only.
Approval Flow
DGS Email*
example@example.com
Dept Business Officer Email
example@example.com
College Business Office Email
example@example.com
Please select one "yes" per request. You will need to select "no" for the other selections.
1. Are you requesting a stipend for a graduate student?*
Start Date

MonthDayYear
Date
End Date

MonthDayYear
Date
Total Stipend & Benefits
2. Are you request a tuition payment via a SAG form?*
Fall Tuition
Spring Tuition
Total Tuition Request
3. Are you requesting funds for a graduate student to present research at a conference?*
3. Amount Request for student to present research at conference:
3 . List name of conference/meeting, location, paper/presentation title and meeting dates.
4. Are you requesting funds for a graduate student to travel to conduct research/training for thesis/dissertation?*
4. Amount request for student to travel to conduct research/training for thesis/dissertation?
4. For research/training, include purpose, location and travel/training dates
5. Are you requesting funds for a graduate student's registration to attend a virtual conference/meeting? *
5. Total requested for registration fees
5. List name of conference/meeting, location, paper/presentation title and meeting dates.
Total Request:
How will support from Block Funding contribute to overall graduate program/graduate student success?*
Note: Student signature is not needed with the DGS is requesting stipend or tuition. Student signature is only needed when requesting travel expenses.
Should be Empty: