Augsburg College Center for Teaching and Learning
(APPLICATION Due Date: One month prior to travel)
Return this application for the the Center for Teaching and Learning, CB 97, or as an e-mail attachment to <CTL>. Your application will not be accepted after the conference occurs and must be typed or wordprocessed.
Name_________________________________________________Date____________________
Department_____________________________________________FTE____________________
Conference Title:________________________________________________________________
______________________________________________________________________________
Conference Location______________________________________Date____________________
1. Please describe your role at the conference. Will you present, moderate a session, serve as a panelist, etc? (Funding amounts depend on the description of your activity.)
2. If presenting, please give the title of your presentation.
3. Please describe how this conference will relate to your professional development.
4. Have you sought funding from the DeanŐs Travel Fund? (For faculty only.) Circle one: YES. NO. If yes, how much funding did you receive? $_________________ If no, why not?
5. Will you receive travel support/funds from other sources? YES. NO. If yes, please describe.
6. Anticipated costs
Airfare & surface travel $__________ TOTAL REQUESTED* $________
Hotel $__________
Registration $__________
Meals $__________
Other (specify) $__________ Signature:
TOTAL $__________ ______________________________
6/03