Education Graduate Student Professional Development Funds Application

Please complete the form below.

First Name

Middle Name

Last Name

Birthdate

Daytime phone

Rockhurst Email Address

Degree you are pursuing

Department in which you are enrolled

Total amount requested

Type of request

Request funds for Conference Attendance

Conference Name

Sponsoring Organization

Conference Location

Conference date(s)

Indicate Scope of the Conference

Indicate your role

Presenter

Presentation of

If other, please explain

Title of presentation

List of co-authors (if any)

Attendee only

Reasons for attending

Costs associated with the conference

Registration

Travel

Lodging

Meals

Other

Request Funds for an event or speaker

Name of organization

Explain how program/event/speaker will benefit students

Cost associated with the event (Please itemize)

Speaker stipend

Other (please itemize)

Request for funds for purpose other than the above

Explain the purpose of your request

Associated costs (amount and purpose)

Have you received prior funding?

If yes, give the amount and date funds were received

Are you receiving funding from another source?

If yes, indicate the source and amount

Additional Comments