Request for Travel Support

All fields must be filled out completely.

Contact Info.

Name:     Date: 
Student/Employee id:
Title/Student Status:
Department/Academic Program:
Address:
Phone:     Email: 

Travel details

Conference/Workshop/Seminar name:  
Location:      Date(s) of travel:  
Purpose of Travel:
Are you presenting at this conference/workshop/seminar?   Y / N
NOTE: If you are presenting at a conference and your funding request is approved, we will forward your presentation information to the LGBT Studies Program for consideration for an on-campus presentation as well.
Relevance of travel to LGBT topics:  
How will your travel benefit NIU upon your return?  
Sources of Revenue: Please list all other sources of funding support and amounts;
indicate whether funding requests are approved or pending.

Estimated Cost

Transportation:  
Registration:  
Lodging:  
Meals:  
Other costs:  
TOTAL:  

Send your conference registration acceptance letter to pcsogi@niu.edu