Participant Travel Request

This form should be submitted by participants of IN LSAMP requesting travel support for events between December 1, 2020 and April 30, 2023. This should not be used for events that have already occurred.

Student University Email*

First Name

Last Name*

Event Name*

Location*

City, State If event is virtual, please write "virtual"

Event Start Date*

Event End Date*

Budget

Itemized list of travel expenses

List all items requesting reimbursement. (registration, airfare, mileage, hotel and per diem)

Travel Cost*

$ amount only (i.e. $500)

Attending conference as

Select all that apply.

Select

Justification*

Limit to 250 words. Define purpose and benefit of attendance.

Has your conference abstract been accepted?

Select or enter value

My abstract was accepted on this day:

Please list date of anticipated acceptance notification per the conference website.

Campus Details

College/University*

Select

Campus Coordinator*

Select

Travel Contract*

The IN LSAMP Travel Contract is effective for IN LSAMP scholars who request program funds for travel related to conferences and other events. Please complete the contract and return to your campus coordinator/director.

I have completed and submitted the IN LSAMP Travel Contract to my campus LSAMP coordinator/director.

Select

Questions

Send me a copy of my responses

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