Travel Stipend Request Form

Travel Stipend Request Form

Building Next-Gen Leaders Conference
Thank you for your interest in attending our Conference on Building Next-Gen Leaders!

We understand that attendance can be cost prohibitive, and we are offering a limited number of travel stipends to support participants in joining us. Please note that travel stipends are not guaranteed. We will review all requests and notify applicants of their status as soon as possible. Please fill out the form below so we can better understand your needs.

Note: Travel stipends are limited so please submit this form as soon as possible. Available stipends are capped at a maximum of $500 for in-region guests and $850 for out-of-region guests.
Full Name*

First NameLast Name
Email*
example@example.com
Phone Number
Please enter a valid phone number.
Organization/Institution *
Position/Title/Role*
Location and Travel Details
City and State of Residence *
Ex: Houston, TX
Is your residence considered 'in-region' (i.e. Arizona, Utah, Nevada, California) or 'out-of-region'?*

In-RegionOut-of-Region
What will be your mode of travel? (Check all that apply)*

AirplaneTrainBusPersonal VehicleOther
If 'other' please describe:
Program
Please select which events you plan to attend.*

Full-day Conference (Monday, October 20th)Cocktail Hour (Sunday, October 19th 4pm-6pmPST)BOTH
Stipend Request

Maximum of $500 for in-region, $850 for out-of-region. Individuals are only eligible to receive one travel stipend to attend the events listed below.
Estimated total travel costs: *
Amount of travel stipend requested:*
Please explain why you are requesting financial assistance for travel:*
(e.g., personal financial considerations, lack of institutional support, member of an underrepresented community, etc.):
Is your employer or institution offering any financial support for your travel to the conference?*

YesNoPartially
If 'Partially' please provide details:
By attending the Building Next Gen Leaders Conference, how do you plan to apply what you learn to advance dialogue, inclusion, or student leadership efforts in your community, campus, or field of work moving forward?
Agreement

By submitting this form, I acknowledge that:
I have provided accurate information regarding my financial need.*

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Travel Stipend Request Form

Location and Travel Details

Program

Stipend Request

Agreement