Document 15097665

NCUWM Travel Support Request Form
To request travel support from the Nebraska Conference for Undergraduate Women in
Mathematics, please attach this form to an e-mail sent to [email protected] Please
make the subject line “Travel Support Request”. You will also need to have an e-mail sent
to the same address from your academic advisor or Department Chair explaining that your
institution cannot cover all of your travel expenses. Please remember that most of your
expenses during the conference will be covered by the conference.
Name: __________________________________________________________________
Email Address and Phone:
Position: ________________________________________________________________
(For most of you, this should be “undergraduate student”.)
Institution (including address):
Institutional Funding Contact (name, email/phone, best times to reach):
Estimated Travel Expenses (Please give exact values if you have them): Good estimates
for airfare can be obtained by going to an online travel service such as Orbitz or
Airfare or gas: ___________________________________________________________
Transportation to and from your local airport: __________________________________
Total Estimated Expenses: __________________________________________________
Amount of expenses listed above being covered by your institution: __________________
Amount of expenses listed above requested from the NCUWM: _____________________