Request edit access
NSGIC 2019 Midyear Meeting Travel Grant Application
NSGIC Members Only: Please complete this application, in full, to be considered for a conference travel grant.
Name *
Last name, First name
Your answer
Organization
Your answer
State
Your answer
Phone Number
Your answer
Email
Your answer
Amounted Requested: Travel *
If applicable, how much money are you requesting for mileage or airfare?
Your answer
Amount Requested: Registration (PLEASE NOTE: Whenever possible, we ask that grant recipients verify whether their organization might cover registration expenses if NSGIC offers travel funding) *
Amount Requested: Hotel (PLEASE NOTE: Whenever possible, grant recipients are asked to share a guestroom in an effort to reduce expenses) *
If applicable, how much money are you requesting for hotel stay (The per diem rate is $138.00 plus 16.07%)
Your answer
Amount Requested: TOTAL
This field will automatically calculate the sum of all funding values entered above.
Your answer
How many days of the conference will you attend?
Your answer
Are you a NSGIC member?
Have you received a NSGIC travel grant in the past?
Please indicate highest level of NSGIC committee involvement
Please indicate past participation in NSGIC
Are you a State Coordinator or State Delegate?
Please provide a brief description of grant need *
Your answer
Submit
Never submit passwords through Google Forms.
This form was created inside of NSGIC. Report Abuse - Terms of Service