Human Performance and Health Education

HPHE Travel Funding Request

Department funding only.

First Name (required)

Last Name (required)

Email (required)

Status (required)

Department Coordinator (required)

Department Coordinator (if applicable)

Office Coordinator Email

A copy of this form will be sent to this email address.

Type of Event/Name of Conference (required)

Business Purpose (required)

(If presenting, attach letter of acceptance, abstract of paper to be presented and details about the conference. If professional development please attach abstract how the activity will enhance teaching, research or service.)

Purpose of Travel (required)

If other please explain

Departure Date (required)

Return Date (required)

Course Coverage Plan (required)

Course Coverage Plan (if you are a teaching assistant)

Other Funding (required)

(ex: Faculty Research Travel Fund $800, Dept XYZ $200, Haenicke Institute $500)

Abstract Attachment

One file only.
2 MB limit.
Allowed types: txt rtf pdf doc docx odt ppt pptx odp xls xlsx ods xml.

Additional Attachment

(letter of acceptance, additional abstract, etc.)
One file only.
2 MB limit.
Allowed types: gif jpg jpeg png txt rtf pdf doc docx odt ppt pptx odp xls xlsx ods xml.