The ICGD Faculty Award

Name Name First Last
Title and Rank
Department
College
Phone Phone - ### - ### ####
Email
I. Conference Information
Name of Conference
Location
From Date From Date / MM / DD YYYY
To Date To Date / MM / DD YYYY
Title of Presentation
II. Expenses: A cost estimate of the proposed activity.
Transportation: $ Dollars . Cents
Lodging (room rate x days): $ Dollars . Cents
Conference Registration $ Dollars . Cents
Miscellaneous (must be documented): $ Dollars . Cents
Total estimated or actual expenses: $ Dollars . Cents
Contributions from a grant or source other than your personal funds: $ Dollars . Cents
Amount requested: $ Dollars . Cents
III. Activity
Title of Research Project/Creative Activity
200-Word Abstract of Your Work
Concisely describe the significance of this work in relation to the ICGD's mission.
List of Relevant Publications or Creative Works

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