NSGIC 2017 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
Event
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 (NSGIC rate is $103 plus 13% tax per night. The nightly rate for grants would be $58.20 (inclusive and sharing with another grant recipient)
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?
Ranking: Yes = 0; No = 1
Please indicate highest level of NSGIC committee involvement
Ranking: Not active = 0; Committee Member = 1; Chair/Officer = 3
Please indicate past participation in NSGIC
Ranking: None = 0; Individual participation = 1; State Delegate = 3
Are you a State Coordinator or State Delegate?
Ranking: No = 0; Yes WITHOUT letter = 1; Yes WITH letter = 3
Please provide a brief description of grant need
Ranking: Fair description = 1; Solid description = 2
Your answer
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