6. On a separate sheet of paper(s), please provide the following information:

1. Describe the proposed activity (Attach copy of relevant information; e.g., brochures.)
2. List other participants (Each participant requesting funds must make a separate application.)
3. Describe the anticipated outcomes of this activity
4. Itemize amounts of request (e.g., registration fee, travel, etc.)

7. Please attach one letter of support for this request.

8. Do you anticipate receiving funding for this activity from any other source (e.g. departmental travel funds)?
If so, please explain.

9. One condition attached to the receipt of UCET/FACET funds is that within six months of receiving funds, you will make some type of presentation to other IUSB faculty. Presentations could include conducting a brown bag lunch/discussion group, a formal seminar, a written paper to be put on the UCET Website, etc.

If you agree to this condition, please sign here:  ___________________________

Total Amount Requested:  

Submit completed application with above attachments (#6 & 7) to:

UCET/FACET Awards Committee
UCET Office
Northside 244

* * * * * * * * * * *

Date Application Received:  ____/____/________
Funds Requested:  $_____________
Funds Awarded:     $_____________
Comments:

Signed:  ___________________________  Date:  ____/____/________
UCET/FACET Awards Committee Chair