Today's date:

Name:

email:

UT EID:

Actual Depart Date

Actual Return Date

Reason for Request:

Conference Name:

Conference Location: City/State/Country

Actual Conference Dates:

Paper? Title:

How much will this trip cost? (approx)

Transportation:

Food:

Lodging:

Other:

How much are you requesting?

Are you requesting a Faculty Travel Grant?

(You must be FACULTY presenting a paper):

Yes No

Disposition of Duties:

List abbreviation and course #, day/time and who will cover each.

Account number(s):
Please add if known -- VERY HELPFUL!

Additional Notes: