Rocky Mini-Grant - Individual (Conference Support)

Rockefeller Center Mini-Grant Application - Individual (Conference Support)
This is an application for funding through the Rockefeller Mini-Grants for up to $1000 for conference registration fees and travel expenses. This application is for individual undergraduate students only. Please complete only ONE application per person.
About You
Full Name*

First NameMiddle InitialLast Name
Preferred Name
Nickname, etc.
Class Year*
If your class year is "Other" please specify:
Full Dartmouth E-mail Address*
ex: first.mi.last.17@dartmouth.edu
Dartmouth ID#
ex. d00000a
HB:*
Enter four digits only
Cell Phone Number
Enter numbers only
Legal Home Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Citizenship*
USA or other. If other, please list. If dual citizen, please list all applicable nations
Gender*
Preferred Pronoun*
ex. she/her/hers
Major 1 (intended)*
Major 2 (intended)
Minor 1 (intended)
Minor 2 (intended)
What is your house community affiliation?*
If you live in a Living Learning Community, please select which one.
Conference Information
Please provide the name of the conference you would like to attend.*
Please provide the website for the conference you would like to attend.*
Include http://www.
What are the dates of the conference?*
What is the location of the conference? (city,state)*
How much is the conference registration fee? Mini-Grants will only fund up to $1000 for the conference registration fee and travel expenses.*
Please describe the format and agenda of the conference.*
How do you plan to share what you have learned with others on campus? Some examples include: organize and implement a poster session, be a guest speaker at a Rocky discussion group, present what you learned in a class, or facilitate a formal discussion with a group of other Dartmouth students.*
Please describe how attending this conference fits into the Rockefeller Center's mission: to educate, train, and inspire the next generation of leaders in all endeavors.*
Please mention other funding sources that you are seeking to support your attendance at this conference. Note if funding amount is confirmed or pending.*
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By selecting YES, I understand that my name, bio, and photo will be used in Center outreach and marketing if awarded funding. This may include, but is not limited to: web site, blog, facebook, flickr, posters/flyers, brochures, youtube, newsletters, twitter, and annual report.*
Should be Empty:

Rockefeller Center Mini-Grant Application - Individual (Conference Support)

About You

Conference Information

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