FLOC 2014 Student Travel Support
Please submit only one application. Multiple applications under the same name will disqualify you from being considered.
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Student Information
Name: *
Mailing Address:
Email Address: *
Gender:
(female or male)
Educational Institution: *
Current Degree under Study: *
(BS, MS, or PhD)
Country: *
(the country in which you are currently studying)
Citizenship: *
Ethnic Background:
Do you have a presentation? *
(mark the ones applied, and if use "other" if you are participating in an event that is not included)
Required
Enter the title of your contribution(s) if chose anything other than "None" in the previous question.
Primary Conference/Workshop to attend:
(use other to provide the workshop name)
Clear selection
Academic Supervisor Information
Supervisor Name: *
Supervisor Email Address: *
(Note: enter the same email address from which your supervisor will be emailing us your letter of support to floc14student@gmail.com)
Supervisor Webpage Address:
Supervisor Mailing Address
Funding and Travel Costs
Estimated transportation costs: *
(flights, train or bus rides, etc)
Estimated accommodation Costs: *
(maximum funding provided for 50 euros per day)
Estimated registration costs: *
(based on how many conferences/workshops you plan to attend)
Estimated Total Funding Required: *
Funding Amount Requested: *
What other source will provide the rest of your funding? *
Statement of Interest
Statement of Interst *
Describe, in 300 or fewer words , your interest in attending FLoC, your expected benefit, and your financial need.
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