Please complete the form below:
First name:
Last name:
E-mail:
Mailing Address:
City:
State:
Zip Code:
Phone Number:
Job Title/Student Classification
Department/Major
Title of Project/Conference:
Conference Date/Expected Completion Date:
Location:
Amount Requested:
Conference Website:
Explain the relationship of your research/professional development proposal to issues of diversity in higher education or, for students, to your academic and career goals:
How would this activity benefit the campus community?
Please attach an itemized budget. Eligible expenses include, but are not limited to: airfare, hotel, taxi, food, conference registration, organization membership fees, and research supplies.
List all professional development or other funding sources available to you this fiscal year for this specific project. What is the current status of alternative funding source requests?
Please provide a narrative explanation of how proposed funds will be used and their connection to diversity issues at Minnesota State University, Mankato.
Recipients will be asked to share their diversity related project/experience/results with the university community. Please identify the method(s) and venue you prefer to share your project. Institutional Diversity Workshop Classroom presentation Department and or Division event Undergraduate Research Conference session Other
If "Other" please specify below:
Do you understand that all funds must be expended by June 30, 2012? Yes No
Employees Only: Do you anticipate being employed at Minnesota State University, Mankato the semester following disbursement? Yes No N/A
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