Graduate Student Government Professional Enrichment Grant Application

Transcription

1 Graduate Student Government Professional Enrichment Grant Application Student Checklist: Turn in your application at least 20 business days (4 weeks) prior to the anticipated travel This timeframe is necessary for the SOuRCe and GSG to have time to check Good Standing and process your request. Due to multiple student requests, we want to accommodate all graduate students with enough time to provide the needed attention to review each packet. In addition, we want to help ensure you have enough time to book your trip and receive the best travel deals! Have your Faculty Advisor or Research Advisor review and sign the application Attach supporting documentation to justify the anticipated expenditures and needed information (includes, but is not limited to, all drivers must provide a copy of automobile insurance card current at the time of travel; copy of a valid driver s license; completed consent to participate and release of liability and student emergency contact forms, printed copy showing proof of mileage for personal vehicle use and rental vehicle gasoline costs; documentation of registration fees, documentation of lodging costs) Professional Enrichment Grant Description: As a service to the graduate student body, Graduate Student Government (GSG) allocates a portion of its budget to reimburse travel expenses to academic conferences. Graduate students are eligible to apply for travel funding through the Personal Enrichment Grant (PEG) process. A faculty member or research advisor, and the Graduate Student Government must authorize all travel by individual graduate students. The GSG Budget Subcommittee will review all requests and will use discretion and information provided to allocate financial assistance. Please keep in mind, the PEG program is a grant program as a means to assist graduate students and not all requests can be fully funded. Students are only eligible for one allocation per academic year. General Travel Policies: In order to travel, all students must be in Good Standing (defined on pg. 2 & 5) AND enrolled in the semester in which they plan to travel before submitting the PEG Application with the SOuRCe. Enrollment is verified at the time Good Standing is checked. Students that are not enrolled for the semester in which they plan to travel will be denied funding. Completed applications must be submitted to the SOuRCe at least 20 business days (4 weeks) prior to travel. If the packet is incomplete or is not legible, it will be returned without review. Individuals that apply for a PEG to simply attend a conference will be allocated a maximum of $150 for travel. Individuals that apply for a PEG to present at a conference will be allocated a maximum of $300 for travel. Travel funding is allocated on a reimbursement basis only AFTER travel has occurred. Only applications submitted, reviewed, and approved prior to travel will be considered for funding. In order to receive funding, a student has 10 ten business days (2 weeks) to submit the travel expense report with receipts, conference pictures, and a summary report after travel has occurred. For questions regarding this application, please contact the SOuRCe at or source@uakron.edu 1 P a g e

2 Professional Enrichment Grant (PEG) Process & Guidelines Submitting your application: All applications will be accepted from July 1st, 2013 May 1st, 2014 by the SOuRCe - located on the first floor of the Student Union (within the Center for Service and Leadership). Completed applications must be submitted to the SOuRCe at least 20 business days (4 weeks) prior to travel. Good Standing: Graduate students must be in academic and financial good standing before submitting their applications to the SOuRCe. Students can check for academic/financial good standing through MyAkron (examples of poor standing include academic probation, disciplinary holds, outstanding tuition, etc.). The SOuRCe will determine academic/financial Good Standing of the applicant before routing the paperwork to GSG. The applicant will be informed by the SOuRCe if he/she does not meet the University s definition of Good Standing. GSG will then review the application and use its discretion to approve or reject the application. Supportive Documentation requirements: The following items must be submitted with the application: o The date, time, place of the event/conference o Document all eligible travel expenses [EAF does not reimburse meals or per diem] o Provide printed verification of registration costs, from the host of the conference or event. Funding is paid for the earliest registration date cost, and late registration fees will not be funded with EAF monies; [Documentation can be from a website or printed materials]. o Mode of transportation & documentation of mileage from campus [Suggested: Google Maps and/or directions] o Provide printed documentation or quotes of all eligible travel costs (such as hotel and airfare) [Documentation can be from a website or printed materials] o Applicant and advisor should explain any additional resources and funding available from other sources (such as an academic department or professional organizations) Post-travel requirements: After travel is completed, students will need to submit a Travel Expense Report, signed by the Faculty or Research Advisor, original receipts from expenditures, conference pictures and a summary report within 10 business days. If a reimbursement request form is not submitted to the SOuRCe within 10 business days, funds will be forfeited and returned for other student use. The Travel Expense Report can be downloaded from GSG s OrgSync page as a Microsoft Excel file. 2 P a g e

3 Student Travel Information Student Name: (Please use your FULL name) Advisor Name: Advisor Phone: Advisor Requester Name: Requester Phone: Requester Requester Student ID Number: Are you presenting?: Yes No If Yes, Oral Presentation Poster If No, please explain the reason why you are going: Trip Details: Name of Conference/Event: Provide link to conference website and program: Conference/Event Location: Roundtrip Destination Distance from Campus: miles (Please note: Any trip destination that is further than 125 miles away from campus (1-way), requires you to get a rental car per University guidelines) Travel Date(s): _ Is a UA department providing funding for this trip? Yes No If yes, please include the department name and primary contact person s name and campus extension. What other sources of funding will you use to attend this conference? How will you, and the University, benefit from this experience? (Also mention the significance of the conference to your field of study) All the information provided is correct to the best of my knowledge. I understand that by submitting this application, I will agree to accept the allocation decision provided by GSG. Advisor Printed Name Date Requester Printed Name Date Advisor Signature Date Requester Signature Date 3 P a g e

4 Student Travel Planning Worksheet This document is used to help you plan for your travel. In the boxes listed below please mark each expense you anticipate from this trip. Must provide supporting documentation such as, printed website quotes, conference information, hotel rates, map to destination, etc. in order to be considered for funding. All individuals driving must attach a current copy of their Driver s License and Car Insurance If there are any special circumstances or considerations included in the expenses below, please attach proper justification sheet (pg. 4) that can be used during the allocation process. Travel Expenses (check all that apply to your travel) Total Cost & Calculations Requesting Funding? Office Use Only Amount Allocated Airfare (Only locations over 250 miles from University of Akron will be considered for funding) Rental Vehicle 1 (If destination is over 125 miles from the University, students are required to rent a vehicle. Organization must contact car rental company for estimate.) Mileage Reimbursement (For use with personal vehicle. Amounts are per current University mileage rate. Must provide map stating round trip mileage starting at the University.) University Gas Card(s) (Required for rental vehicle use) Tolls (Must provide documentation indicating tolls and amounts) Registration (Must provide documentation of workshop, competition, or conference costs and materials) Lodging (Maximum allowance is $150.00/night including room tax. Printed cost estimate must be provided) TOTAL AMOUNT GSG Use Only - Review Process & Representatives: GSG Treasurer Signature Date _ GSG Representative Signature Date GSG President Signature Date 1 For rental vehicle estimates, please contact Enterprise Rent-A-Car at (330) Students must be at least 18 years of age to rent any type of vehicle. Those driving a 15-passenger van must be at least 25 years of age. 4 P a g e

5 Special Consideration: Student Org. Travel Justification Form If there are any special circumstances or considerations included on the Travel Planning Worksheet or information included in this packet, please complete this form. These responses will be used by USG/GSG during the allocation process to help understand your request more clearly. Please check the items that should receive special consideration. Airfare (why this type of transportation requested, cost, destination from campus, etc.) Why: Vehicle Rental (mileage, type of vehicle requested, etc.) Why: Registration (special type of registration, cost, etc.) Why: Lodging (cost of lodging, why this location, etc.) Why: Note: If you need more space to provide your justification, please feel free to attach an additional sheet 5 P a g e

6 University of Akron Consent to Participate & Release of Liability I, the undersigned, do hereby state that I wish to participate in activities sponsored by, the University of Akron. University Department/ Conference name The above indicated and The University of Akron make no representations or claims as to the condition or safety of the land, structures or surroundings, whether or not owned, leased, operated or maintained by the University of Akron and/or the above indicated student organization. I understand that all activities are VOLUNTARY and that I do not have to participate unless I choose to do so. I understand that these activities are potentially dangerous or harmful to my person or property and that by participating voluntarily accept and assume the risk of injury to myself, up to and including death, or damage to my property. In exchange for allowing me to participate in these activities and events, I agree to release from liability, agree to indemnify, and hold harmless The University of Akron and the above indicated student organization, and any agent, officer or employees of the University of Akron and any agent, officer or employee of the above indicated student acting within the scope of their duties, for any injury to myself, up to and including death, or damage to my property. This Release of Liability shall be binding upon me, successors in interest, and/or any person(s) suing on my behalf. I have read the statements in this document. I agree with its terms and have voluntarily signed it. I understand that this document is complete unto itself and that any oral promises or representations made to me concerning this document and/or its terms are not binding upon The University of Akron and/or the above indicated student organization or its officers, agents and/or employees. I UNDERSTAND THAT THIS IS A LEGAL DOCUMENT. I HAVE READ AND UNDERSTAND THIS RELEASE AND I UNDERSTAND ALL ITS TERMS. I EXECUTE IT VOLUNTARILY AND WITH FULL KNOWLEDGE OF ITS MEANING AND SIGNIFICANCE. Signature Date Print Name 6 P a g e

7 University of Akron Student Emergency Information NAME OF STUDENT ORGANIZATION: PERSONAL INFORMATION: NAME (LAST) (FIRST) (MI) ADDRESS (STREET) (CITY) (STATE) (ZIP CODE) CELL PHONE ( ) HOME PHONE( ) STUDENT ID NUMBER BIRTHDATE MEDICAL INSURANCE COMPANY PHONE NUMBER PERSON TO CONTACT IN CASE OF AN EMERGENCY: NAME (LAST) (FIRST) (RELATIONSHIP TO STUDENT) ADDRESS (STREET) (CITY) (STATE) (ZIP CODE) CELL PHONE ( ) HOME PHONE( ) DO YOU HAVE ANY MEDICAL PROBLEMS THAT WE NEED TO KNOW ABOUT? No Yes IF YES, PLEASE EXPLAIN: DO YOU HAVE ANY ALLERGIES? No Yes IF YES, PLEASE EXPLAIN: ARE YOU TAKING ANY MEDICATION? No Yes IF YES, PLEASE EXPLAIN: Signature Date Print Name 7 P a g e

8 THE UNIVERSITY OF AKRON GRADUATE STUDENT TRAVEL EXPENSE REPORT NAME: SOC. SEC. No.: ADDRESS: PURPOSE: TIME OF DEPARTURE AND TIME OF RETURN MUST BE SHOWN IN ORDER TO ESTABLISH REIMBURSEMENT ELIGIBILITY COMMERCIAL TRANSPORTATION - Attach receipts Plane from: Other from: DATES Time Departure: Time Return: LOCAL TRANSPORTATION (Mileage) at current rate STUDENT ORG NAME (If applies): DATES - from: LIST EXPENSES BY DAYS IN SEPARATE COLUMNS - IF MORE THAN FIVE DAYS USE ADDITIONAL SHEETS WITH ONE TOTAL TOTAL From: miles: From: miles: From: miles: From: miles: I am ; am not covered by personal vehicle insurance Vehicle Insurance Provider: LODGING - Attach receipts REGISTRATION - Attach receipts DAILY TOTALS : TOTAL: REMARKS OR EXPLANATIONS: I hereby certify that the expenses as detailed above have actually been incurred by me and are proper reimbursable items. In addition, I certify that all prepayments made through the University are shown in memo form herein. I also certify that no expenses are included above for food or alcoholic beverages. STUDENT SIGNATURE: Date: Telephone: ZIP + EAF/SAF ACCOUNTING CODE(S) ADVISOR/FACULTY SIGNATURE: AMOUNT APPROVED $ 8 P a g e

9 THE UNIVERSITY OF AKRON GRADUATE STUDENT GOVERNMENT CONFERENCE SUMMARY REPORT Name: Major: Presented: Conference: Date: Location: Attended: Work presented (title): SUMMARY REPORT (How this conference helped you professionally?) COMMENTS (please provide input about the grant process) 9 P a g e