Student Travel Reimbursement

LSUHSC–NO School of Allied Health Professions

Student Travel Reimbursement Application
SECTION I: STUDENT INFORMATION
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.
Airfare
Lodging
Ground Transportation
Conference Registration
Total Requested
I understand reimbursement is limited to documented, allowable expenses.

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

SECTION IX: FACULTY/ DEPARTMENT SUPPORT
Faculty Advisor or Department Head Name:
Title / Department:
Email
example@example.com
SECTION X: COURSE DIRECTOR APPROVAL (Required if Reimbursed)
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 reimbursements are competitive and contingent upon compliance with LSUHSC travel policies.
- I understand that I am representing LSU Health New Orleans and the School of Allied Health Professions during all School-sponsored or School-funded travel.
- I agree to conduct myself in a professional, respectful, and ethical manner throughout my travel.
- I will comply with all University Travel Policies and Procedures found here.
Signature
Date

MonthDayYear
Date
PLEASE UPLOAD THE FOLLOWING DOCUMENTS:
- Abstract or description of presentation/activity
- Faculty advisor or department head 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