School of Allied Health Professions Student Travel Reimbursement Application

LSUHSC–NO School of Allied Health Professions

Student Travel Reimbursement Application
SECTION I: STUDENTINFORMATION
Name

First NameLast Name
LSUHSC Student ID
Email
example@example.com
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Program of Study
Degree Level
Academic Standing

SECTION V: BUDGET(ESTIMATED EXPENSES)

Maximum award: $1,200 - Meals are NOT reimbursable. Lodging limited to 3 nights.
Airfare
Lodging (up to 3 nights)
Ground Transportation
Conference Registration
Total Requested
I understand reimbursement is limited to documented, allowable expenses.

SECTION VI: PRIOR TRAVEL FUNDINGDISCLOSURE
Have you received an LSUHSC SAHP travel award previously?
If yes, list semester(s), year(s), and event(s):
I acknowledge that students may receive one award per semester and no more than two per academic year, and that repeat applicants may receive lower priority when funds are limited.
SECTION VII: EXTERNALFUNDING DISCLOSURE
Have you received or applied for external travelfunding related to this event?
If yes, list sourceand amount:
I understand that any externaltravel funding must be appliedto allowable travelexpenses and disclosed toStudent Affairs.

SECTION IX: FACULTY/ DEPARTMENT SUPPORT
Faculty Advisor or Department ChairName:
Title / Department:
Email
example@example.com
SECTION X: COURSE DIRECTOR APPROVAL (Required if Awarded)
SECTION XI: STUDENT CERTIFICATION & SIGNATURE

I certify that all information provided in this application is accurate and complete. I understand that submission does not guarantee funding and that awards are competitive and contingent upon compliance with LSUHSC travel policies.
Type a question
Date

MonthDayYear
Date
PLEASE UPLOAD THE FOLLOWING DOCUMENTS:
- Abstract or description of presentation/activity
- Faculty advisor or department chair support letter
- Proof of Acceptance (conference acceptance letter, invitation, or registration confirmation) OR Proof of Submission (email confirmation)
Files Upload

Cancelof
Should be Empty:

LSUHSC–NO School of Allied Health Professions