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Application Form Conference/Symposium Funding Request (Application Must Be Typed)

Please submit completed form to the Faculty of Medicine & Dentistry Dean's Office.

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juicyprunes
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30 views2 pages

Application Form Conference/Symposium Funding Request (Application Must Be Typed)

Please submit completed form to the Faculty of Medicine & Dentistry Dean's Office.

Uploaded by

juicyprunes
Copyright
© Attribution Non-Commercial (BY-NC)
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOC, PDF, TXT or read online on Scribd
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Application Form

CONFERENCE/SYMPOSIUM FUNDING REQUEST


(Application must be typed)
1. Project Manager/Host:
The project manager MUST be a full-time academic staff member in the Faculty of Medicine & Dentistry at the University of Alberta
Name: Application Date:
                 

Surname Given Name(s)

Academic status: Telephone:


           -     -     

Department: Faculty: E-mail:


                 

2. Event Information:
Title of Event:
     

Location (MUST be in Alberta): Date of Event:


      From       To      

Not the end date of the event – leave 6 months for all
expenses/revenue to clear.
Type of Event: Conference       Symposium      

}Will you be charging/collecting registration fees?


No Yes Note: You must collect 5% GST on all registration fees.
Brief description (nature, purpose, importance, topics to be addressed, relation to the U of A).

Do any of the activities planned during this event require biohazards, animal welfare or human ethics
certification?

No Yes
Please explain:
Do any of the activities planned during this event conflict with existing University policies?

No Yes
Please explain:

3. Revenue:

Estimated total cash flow (all revenue)


     

Estimated revenue from donations:


     

Estimated revenue from internal charges (registration fees, etc.)


Sources of external revenue:

Sources of internal revenue:

4. Funding Request:

Please enter the amount requested:

$2,000 for international conferences/symposiums

$1,500 for national conferences/symposiums

$1,000 for provincial conferences/symposiums

4. Signatures:
I agree to hold this project/grant as described in the terms of reference. This is a University-sponsored conference/symposium and
the department listed above accepts any over expenditures.
Project/Grant Manager (Host): Date:
           
Print Name Signature

Department Chair: Date:


           

Print Name Signature

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