University at Buffalo The State University of New York Vice Provost for International Education Faculty Internationalization Fund Application Form In order to be considered, applications must be complete and endorsed by the appropriate department chair and dean. Completed and endorsed applications should be submitted for approval to the University at Buffalo Office of the Vice Provost for International Education at the address below, or electronically to: John J. Wood, Senior Associate Vice Provost for International Education at: jjwood@buffalo.edu. Please attach an updated CV and be sure to complete the travel budget specifying relevant costs and other sources of support. Applications will be considered by the selection committee three times each year, per the following deadlines for submission: October 1, February 1, and May 1. Awards will be made within two weeks following each deadline. Please check the appropriate category: ___ Study Abroad Program ___ Collaborative Research ___Course Enhancement 1. APPLICANT NAME: 2. ACADEMIC RANK/TITLE AT UB: 3. UB DEPARTMENT: 4. CAMPUS ADDRESS: 5. TELEPHONE: 6. EMAIL: 7. TITLE OF PROPOSED ACTIVITY: 8. HOST INSTITUTION/COUNTRY: 9. COLLABORATOR(S) AT HOST INSTITUTION: 10. PROPOSED DATES OF TRAVEL TO HOST INSTITUTION: Study Abroad Programs International Student & Scholar Services International Enrollment Management 411 Capen Hall, Buffalo, NY 14260-1604 U.S.A. Tel: (716) 645-2368 Fax: (716) 645-2528 E-mail: intadmit@ buffalo.edu Web: www.buffalo.edu 11. FUNDING AMOUNT REQUESTED (Please complete the travel expense budget [page 4] to substantiate request and indicate any other anticipated funding support): ___ $500 ___$1,000 ___$2,000 12. SUMMARY OF PROPOSED ACTIVITY (50 Words): 13. PREVIOUS EXTENDED VISITS ABROAD FOR RESEARCH, SCHOLARSHIP OR TEACHING: 14. DESCRIPTION OF PROPOSED ACTIVITY (up to 500 words): Describe the study abroad program, collaborative research, or course/curricula enhancement activity you plan to develop at the host institution. In what specific ways will you collaborate with the host institution? 2 Indicate how your visit will benefit yourself, your institution, and UB. 15. OTHER POSSIBLE ACTIVITIES THAT YOU MIGHT UNDERTAKE AT THE HOST INSTITUTION (TEACHING, LECTURING, ETC): 16. SIGNATURES/APPROVALS: APPLICANT SIGNATURE: DATE: DEPARTMENT CHAIR SIGNATURE: DATE: DEAN’S SIGNATURE: DATE: 3 Faculty Internationalization Fund: Travel Expense Budget To justify the funding amount requested, please complete the Travel Expense Budget with as much specificity and precision as possible. List anticipated actual costs obtained in consultation with host institutions/colleagues; do not list per diem amounts. Only actual costs will be reimbursed with the presentation of original receipts (with translations when necessary). Note: FIF funds will be transferred to the faculty member’s department, which will administer the travel reimbursement. Name ___________________________ Destination(s) _____________________________ Amount Requested ____ $500 Transportation ___ $1,000 ___$2,000 # of days Cost per day Total (in US dollars) # of days Cost per day Total (in US dollars) Air Transportation Surface Transportation Subtotal Lodging & Meals (Do not use per diem) Lodging Meals Subtotal Grand Total Please list all other anticipated funding support from UB: Please list any anticipated funding or in-kind support from the host institution: 4