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LAS FACULTY FOREIGN TRAVEL FUND REQUEST

DATE:


NAME:	DEPT:
EMAIL:	M/C:

DATES OF EVENT/TRAVEL: to	LOCATION (City, Country):
NAME OF EVENT and SPONSORING ORGANIZATION / RESEARCH SITE:
NATURE OF PARTICIPATION: Please fill in this information using return key; only visible text will print. ATTACH COPY OF INVITATION AND ADDITIONAL PAGES AS NEEDED.

ESTIMATED EXPENSES:
Airfare: $ + Other Transport: $ =	$
Registration:	$
Benefits of Registration (no. of meals, no. of days lodging): Please use return key; only visible text will print. Attach additional pages if needed.
Per Diem (number of days x $32):	$
Lodging (number of days x rate):	$
Other (specify). Please use return key; only visible text will print. Attach additional pages if needed.	$
TOTAL ESTIMATED EXPENSES:	$
FUNDING SUPPORT:
Departmental Contribution:	$
Grant or contract:	$
External Award(s):	$
	$
Department ( Authorized Signature):
Department ( Authorized Signature):	$
Other:	$
TOTAL FUNDING SUPPORT:	$
(For LAS office use. Please do not complete this item.)

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601 South Morgan Street (MC 228) Chicago, Illinois 60607
Administration Tel: (312) 413-2500 | Fax: (312) 413-2511
Student Academic Affairs & Advising Tel: (312) 996-3366 | Fax: (312) 413-8577

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Last Modified: Friday, 02-Sep-2011 15:19:17 CDT