TRAVEL AWARDS APPLICATION FORM

The University of Texas at El Paso

APPLICATION DEADLINE – Rolling

Save & Return

Save your progress and complete this form later. (optional)

Background Information

First Name *

Middle Initial

Last Name *

Street Address *

Address Line 2

City *

State *

Country *

Zip Code *

Phone Number *

Cell Phone Number *

Email Address *

Re-enter email address *

Preferred method for us to contact you *

Home phone

Cell phone

Email

Are you supported by the BUILDing Scholars Program *

Yes

No

Note: Selection to the program will not be influenced by the prior identification of a faculty mentor

Conference/Meeting Information

Conference/Meeting (Provide exact title) *

0/700 words

Street Address *

Address Line 2

City *

State *

Zip Code *

Phone Number

Conference/Meeting URL *

Depart Date * +

Return Date * +

Statement detailing the benefits you will receive by participating in the meeting other than presenting and discussing your research (700 words max.) *

0/700 words

Costs and Funding

Transportation (Air/Car/Rail): *

Lodging *

Conference cost(s) *

Other funding cost(s)

Estimated Total Travel Costs:

$0.00

	Fund Source	Amout	Acct #	Email
Home Dept	Fund Source	Amout	Acct #	Email
College	Fund Source	Amout	Acct #	Email
Other:	Fund Source	Amout	Acct #	Email
Other:	Fund Source	Amout	Acct #	Email

Documents

Attach abstract and proof of abstract acceptance (1MB max) *

CV listing all the current sources of funding you are/have been receiving (5MB max) *

Attach a letter of support from your BUILD mentor (2 pages max, 5MB max) *

A completed application must be submitted a miniumum of six weeks prior to the conference.

Contact Information:

BUILDing SCHOLARS

Email: buildingscholars@utep.edu