First Name
*
Last name
*
Preferred Name / Nickname (if different)
Email
netid@u.rochester.edu
UR ID
*
Your 8-digit UR number, not your Net ID
Class year
*
Major(s); please enter UNC if uncertain at this time
*
Current Amount Requested
*
Whole numbers ONLY!
Start Date
*
-
Month
-
Day
Year
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End Date
-
Month
-
Day
Year
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WHERE will your experience take place?
*
UR River Campus
UR Medical Center
Other US Location
Other non-US/International Location
For travel OUTSIDE THE U.S.:
Use the Worldcue Trip Planning Tool to access updated, destination-specific intelligence information via the
Worldcue Planner
(Net ID required)
Register your travel with the UR
Review the
CDC travelers’ health page
Review the
US Department of State’s Country Information
Please confirm that you have reviewed relevant destination-specific travel information via the links provided above:
*
Yes
Please enter the UR or URMC department of your experience. If this is an independent project, please enter your own department.
*
UR/URMC department here (e.g. BME; Cardiovascular Research Institute; History, etc.)
Please enter CITY and STATE or COUNTRY of your experience. You may select multiple locations, if applicable.
*
e.g. Shanghai, China; El Paso, TX
How would you classify your experience or fund use? Please check all that apply.
Study abroad travel
Research position or internship
Non-research internship
Program expenses (summer, winter break, or spring break only)
Research materials or other project supplies (including memberships)
Conference expenses
Other
Please describe the proposed experience and expense(s) in greater detail. Explain how the expense(s) will be used and provide an estimated budget of your expense(s).
*
e.g. I will purchase a flight to New Zealand for my fall study abroad experience in Christchurch. Flights are currently between $1200-$1350 so I am requesting $1350. I will also need $200 for a 3-month train pass so I can travel back and forth to my internship.
Your request MUST BE APPROVED by a full-time UR faculty member. WHO will you ask to approve your request?
*
Approver first & last name.
With what DEPARTMENT or PROGRAM is your approver affiliated?
*
UR/URMC department here (e.g. BME; Cardiovascular Research Institute; History, etc.)
Approver email (please enter carefully!)
example@example.com
**Please read carefully!** A copy of this form will be emailed your UR approver with a link to an approval form; please let your approver know that you have submitted a request for RIG disbursement.
*
YES, I understand that it is my responsibility to let my approver know that I have requested funds from my RIG and to expect an email from the Office of Undergraduate Research requesting their approval.
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