Updated August 2015
SMITH COLLEGE
STUDENT FUNDING APPLICATION
Funding is for enrolled, undergraduate students only. Submit a hard copy of this application, with
appropriate attachments, to the Dean of the College’s office, College Hall 203, prior to attending the
event –retroactive funding is not guaranteed. Questions? Contact Susan Zachary at szachary@smith.edu.
?? IS THIS THE RIGHT FORM FOR ME ??
Are you applying for funding as an individual
student for an event within the United States
that is NOT for credit?
Are you applying on behalf of a student org?
Are you looking for help with textbooks?
Are you applying for funding for international
travel? (includes Canada and US territories)
YES! – use this form
No - Do not use this form – use the SGA Universal
Funding Application available on the SGA website
under “funding”
No - Do not use this form – use appropriate forms at
www.smith.edu/classdeans/funding.php
No - Do not use this form - apply for an International
Experience Grant at www.smith.edu/studyabroad/ or
Students’ Aid Society at www.smith.edu/classdeans/
IF THIS IS THE CORRECT FORM FOR YOU:
1. Complete and sign the attached application, including checklist and detailed budget (travel costs,
registration, supplies, etc.). Incomplete applications budget will not be considered.
2. Attach official information describing the event you wish to attend, showing the dates and cost.
3. Attach a brief proposal (no more than one page) for your participation in the event, including a
description of the program and how it will benefit your academic career and/or the Smith community.
4. Attach a brief statement from a faculty member supporting your participation in the event.
5. Submit all materials to the Dean of the College office, College Hall 203 PRIOR to attending the event.
Retroactive funding is not guaranteed.
6. Once your application has been reviewed, you will be notified of the amount of funding approved.
7. To receive reimbursement, you must submit original receipts and a completed Student Expense Report
(attached, last page) to the Dean of the College office within one week of the conclusion of your event
or funds may be forfeited; once receipts are approved, funding will be processed.
FUNDS COVERED BY THIS FORM INCLUDE:
SOURCE
The Dean of
the College’s
Office
Ada Comstock
Scholars
Office
Chapel
Office of
Multicultural
Affairs
Class Deans’
Office
FUNDS AVAILABLE FOR
ASSISTANCE WITH:
expenses to attend academic
conferences
participation in co-curricular events,
projects associated with Special
Studies, etc.
expenses for travel to interviews,
conferences, etc.
NOTES
travel to conferences/retreats/special
programs related to religion, ethics
or community/public service
activities that promote a diverse
campus community
amount varies
Special Studies projects
one-time funding; traditional aged students
on financial aid only; amount varies
students may be funded up to a total of
$350 in their time at Smith
maximum total of $100 during time at
Smith.
available to Ada Comstock Scholars only
amount varies
Updated August 2015
STUDENT FUNDING APPLICATION - CHECKLIST
Your Name:
Class Year:
Please √ check all the way to the bottom:
I have read and understand the instructions.
I am an enrolled Smith undergraduate and will complete my proposed activity before
graduation
My project/event takes place in the United States
I will NOT miss any classes in order to participate in my proposed activity
OR
I WILL miss class, and have informed my instructor(s) and arranged to make up any missed work
I have completed the detailed budget form and have attached it to my application
I have attached a brief statement about my proposal and my background that demonstrates relevant
experience and my interest in this project
I have attached a statement from a faculty member/adviser supporting my participation in this event.
I have attached a cheap Internet air, bus, or train quote, if applicable
I have attached an official publication describing the program/project that includes the dates and the cost
(website materials acceptable).
I understand that I must bring original receipts and a completed Student Expense report to the Dean of the
College office within one week of the conclusion of the event in order to receive reimbursement
I understand that if my expenses are less than the approved funding amount, I will be reimbursed only for
the amount spent, and not the full approved amount.
My signature certifies that the information provided and the answers to all questions are accurate on all forms
submitted.
Signed ________________________________________ Date_______________________
(Original signature required)
CHECK THE SOURCE(S) YOU WISH TO APPLY FOR (see previous page for brief descriptions and
restrictions):

SOURCE
The Dean of the College’s Office
Ada Comstock Scholars Program
Chapel
Office of Multicultural Affairs
Class Deans’ Office
Updated August 2015
STUDENT FUNDING APPLICATION
Please complete all sections.
YOUR NAME:
YOUR CLASS YEAR:
SMITH ID #:
YOUR SMITH email address:
Title of the program/project for which you are requesting funding :
Dates : From :
To :
Total number of days :
Does this include days on which you have classes scheduled ?
Yes
No
Location of event :
Funds requested : $
(Use final figure from budget sheet, overleaf)
Please check:
___This project IS ____/is NOT ____ for academic credit.
___ I have completed and attached the Checklist.
___ Are you a U.S. citizen or a permanent resident? Yes____ OR an International Student? Yes____
___ I understand that on completion of the project/event, I must provide original receipts for expenses
incurred and submit them with the completed Student Expense Report within one week of the conclusion of
the event to Susan Zachary in the Dean of the College office, College Hall 203, or my funding may be
forfeited.
______________________________________________
Student’s signature
___________________
Date
FOR OFFICE USE ONLY:
Office supplying
funds:
Approved
by:
Fund
Source
Charge # (to be completed by DOC
Amount office once finalized)
To Controller: Please arrange for direct deposit in the amount of $__________ , to be paid to this
student:________________________________________ ID#_______________________________,
Authorized signature:____________________________________
Date:_______________
Updated August 2015
BUDGET PROPOSAL
Your Name:
Program Title:
Class Year:
(1) Please fill in applicable information:
Registration fee
$
Travel – select appropriate mode(s) of transport below:
$
Air $_______ Train $______ Bus $______ Taxis $______ Gas* $_______
*If driving, calculate mileage, divide by average miles per gallon for your vehicle
to find number of gallons needed, then multiply by average gas cost per gallon.
Meals – Use approximate amounts suggested here:
Breakfast:
$5 x ____ number of b’fasts = $_______} Approximate
Lunch:
$10 x ____ number of lunches = $_______} total cost of
Dinner:
$15 x _____number of dinners = $_______} meals →
$
Accommodation $_______ per night multiplied by ____ number of nights
$
Supplies, if applicable (please be specific; list on separate sheet if necessary)
$
Add the above items to calculate Total Cost of Event
$
WE EXPECT YOU TO CONTRIBUTE TOWARDS THE COST OF THE EVENT
How much are you contributing?
$
Subtract your contribution to arrive at NEW COST OF EVENT
$
(2) Are you receiving PRAXIS funding for this event? Yes _____ or No _____
(3) List all other sources (excluding the offices listed on this form) from which you have
received or applied for funding for this event (e.g. departmental funding, Smith Students’ Aid
Society, SGA conference fund):
Source _________________________________________ Amount of approved funds $_______
Source _________________________________________ Amount of approved funds $_______
Source _________________________________________ Amount of approved funds $_______
Total funds from other sources
$_______
(4) Please complete calculation:
Enter NEW COST OF EVENT (last line in Section 1 above)
$
Subtract total funding obtained from other sources (sum of Sections 2 and 3)
$
Final Cost of Event (this is the amount you are requesting - enter this figure
on first page of this application under “ Funds Requested”)
$
(Attach this sheet to your application)
Updated August 2015
STUDENT EXPENSE REPORT
(Do not attach this sheet to your application – submit with receipts at conclusion of your event)
Name:
ID# :
Name of event the funds were used for:
Complete this form and submit with original receipts to College Hall 203 within one week of the conclusion
of the event, or funding may be forfeited.
Please TAPE your receipts (do not use staples) in a single layer to 8-1/2x11”
sheets of paper so that each is visible, and note what each was for.
MON
TUE
WED
THU
FRI
SAT
SUN
Date
TOTALS
Registration
Meals
Accommodation
Transportation
Supplies
Other (specify)
TOTAL EXPENSE
PER DAY:
Amount pre-approved for this event:
$
The attached receipts total:
All expenses listed on this report were incurred by me while engaged in, and directly related to, the activity for which funds
were given.
Student’s original signature:_________________________________________ Date: _______________________