Application - Academies

Western New York Prosperity Fellowship Program Enrichment Fund
Section I: Application Instructions
The Western New York Prosperity Program Enrichment Fund is intended to provide financial support to Prosperity
Fellows seeking to participate in experiential learning opportunities related to their academic interests and that meet
the WNY Prosperity Fellowship program outcomes for Fellows. This grant is available only to University at Buffalo
students who are in good standing in the WNY Prosperity Fellowship Program. The maximum award amount is $1,500;
however students are welcome to request funding in various increments as opportunities arise with a total award of
$1,500 for the academic year. Applications are accepted on a rolling basis and typically are reviewed at the end of each
month by the WNY Prosperity Fellowship Program. Please note, only applications that follow the instructions below and
are submitted in their entirety to Christina Giunta at considered for funding.
Examples of funded activities include but are not limited to: Presenting at or attending conferences, field school
participation, dance intensives, copies needed to gather data during a thesis process (i.e. surveys, questionnaires),
presentation materials (poster printing, etc.), workshop participation, alternative spring break, study abroad (Winter
(not to conflict with the WNY Prosperity Winter Session Seminar)/ Summer). Examples of ineligible activities to request
financial support include professional licensure examination preparatory classes or fees associated with said
examinations, as well as travel or other associated costs related to graduate or professional school visits.
A completed application must contain the following parts:
PART 1: Personal Information
PART 2: Impact
PART 3: Budget (use accompanying form)
PART 4: Supporting documentation that may help support your application for funding.
PART 5: W-9
PART 6: Agreement
Submit the completed application (with original signatures) to:
Christina Giunta
Undergraduate Academies
17 Norton Hall
Buffalo, NY 14260-1820
Page 1 of 4
Section II: Application
Part 1: Personal Information
Student Name: ____________________________________ Person Number: ________________________________
Email Address: Telephone: _______________________________
Class Year (FR/SO/etc.):_______________ Expected Graduation Date: _____________________________________
Academic Discipline Affiliated with the Activity:____________________________________________________________
Activity: ______________________________ Location of Activity: ___________________________ Dates: ___________
Total Amount of Money Being Requested: __________________________________________________
Part 2: Impact
Write a 2 to 4 page persuasive statement to support your funding request.
1. Describe this experience and explain how it fits in with your academics, career goals, and/or overall educational
2. How does this opportunity complement or enhance your WNY Prosperity Fellowship Program experience?
3. Why should the WNY Prosperity Fellowship Program support you in this endeavor?
Be sure to include a program brochure, official description of the course, conference that you are requesting financial
support from the WNY Prosperity Fellowship Program Enrichment
(Continued on next page)
Page 2 of 4
Part 3: Budget Form
Please use this form or attach a spreadsheet that follows the same format and content included below.
Section A: Summarize all project related expenses (including dollar estimates) you expect to incur as a result of the
Details (If applicable)
Funding Sources (Ex. Self,
Honors College, Other)
Bus, Train, Car, etc.
Local Fares (Bus, Taxi)
Conference Fee
Other Conference Fees
(Funding from Other Sources)
Total Amount of Funding from Other Sources……………………………………………………..
Total Amount Requested from the WNY Prosperity Program……………………………………
Section B: Provide a listing of other sources of support within your Department, at the University, and elsewhere which will
contribute to paying for your experiential experience related expenses.
Tickets may be purchased prior to receiving confirmation that you will be awarded conference assistance. However, the
WNY Prosperity Program is in no way liable for paying your tickets if your application is not funded. To purchase a ticket
before being awarded the grant is to do so at your own risk.
This fund will pay for gas but will not pay a premium for “wear and tear.”
Tolls should be budgeted into the application in order to be claimed.
Be sure to keep all boarding passes, tickets, receipts, credit card statements, or payment statements (i.e. Expedia, etc.) to
support all expenses incurred to document all travel.
The WNY Prosperity Fellowship Program will fund travel based on the rates laid out by the State Department. These rates
can be found at the following website:
.jsp&P=MTT. The WNY Prosperity Fellowship Program reserves the right to cap these amounts at their discretion.
Page 3 of 4
Part 4: Additional Support or Supporting Documentation
Please attach your resume and any additional supporting documents or letters of support that will strengthen your
Part 5: W-9
Please complete and attach a signed W-9 to your application:
Part 6:
If my request is funded and upon return from the enrichment experience, I ________________________________ agree to
Print Student Name
provide a written two page reflective report and share photos of the experience as appropriate. The response paper will be due
30 days after the funded experience has concluded. Please be prepared to submit receipts to confirm expenses incurred. My
reflective paper will include the following elements in my response.
Describe your experience and relate what you learned to the goals of the fellowship program?
How did what you learned contribute to your understanding of the issues affecting WNY economic
development and how do you anticipate it will impact your studies, career plans and/or future employment
prospects in western New York?
Note: In addition to the reflective paper, Fellows will be required to submit copies of receipts, boarding passes, tickets,
credit card statements, or payment statements (i.e. Expedia, etc.) to support all expenses incurred to document all travel and
program related expenses.
Student Signature
Page 4 of 4