University of Colorado Anschutz Medical Campus

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President’s Fund for the Support of Student Diversity - Travel

*For Multi-line Textboxes, Please use your Preferred Word Processor to Assist in Answering These Questions, and Simply "Copy and Paste"

*NOTE: In order to be considered for funding, funding sources require that a student group have an account, in good standing, with your University campus prior to being considered for funding.

**The President’s Fund will not consider proposals for travel outside the continental United States

Today's Date*
Funding Deadline*
Group Name*
Group Address*
Group Phone*
Number of Student Members*
Number of Non-Student Numbers*
Group Has Account with the University of Colorado*Yes
No
Name of Conference or Travel Business*
Travel Destination***
Dates of Travel (Departing and Returning)*
Number of Travelers (President's Fund will only fund up to 2 travelers)*
Traveler #1*
Traveler #1 Student ID*
Traveler #2*
Traveler #2 Student ID*
Traveler #3*
Traveler #3 Student ID*
Traveler #4*
Traveler #4 Student ID*
Traveler #5*
Traveler #5 Student ID*
**Travel Contact (Must be a Traveler) (Full Name as AUTHORIZED SIGNATURE)*
Travel Contact Address*
Travel Contact City*
Travel Contact ZIP*
Travel Contact Home Phone #*
Travel Contact Work Phone #*
Travel Contact Email Address*
Designated Budget (Total Cost in Dollars)*
Breakdown In Regards to Budget*
Give a brief synopsis of the content of the conference/competition (i.e., topics to be discussed, etc.) If you are attending a conference, please attach a copy of the conference brochure.*
Is your group a member of or have a relationship with the conference’s sponsoring organization? If not, how did your group learn about the conference/competition?*
Explain how attending this conference/competition will benefit your campus (the wider university) community? What will your group do with the experience/information gained by attending?*
What type of forum is your group planning to utilize to inform your campus about the information from this conference/competition?*
If your group has attended this conference/competition in the past, please summarize experiences and funding history.*

Office of Inclusion and Outreach

University of Colorado Anschutz Medical Campus

13120 East 19th Avenue | Educaton 2 North 3118

Aurora, CO 80045

o 303.724.8003 | f 303.724.8006 | e OIO@UCDenver.edu

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