Fill and Sign the Ocl Intake Form and Instructions English 2016 Ocl Intake Form and Instructions English 2016 Ontariocourtforms on

Foundation Fellows Research/Conference Grant Application Grant Application Guidelines & Checklist Submission Deadlines - Note: Your grant money will not be approved if submitted after the Grant applications must be submitted 2 deadline unless you have submitted an extension form before the months before the conference or research deadline AND it has been approved. Extensions are evaluated on an project with the exception listed below for the individual basis. final semester of a fourth-year student.  December 7: deadline for 4th years to apply for research/conference funds Before Submitting a Formal Grant Request Deadlines that fall on a weekend or holiday will be extended to the following business day. Yes No Comments Do you have grant money remaining? Have you completed travel reports for all previous endeavors in which grant money was used? We cannot award a new grant if you have overdue travel reports. Have you discussed the academic merit and viability of your conference or research project plans with Jessica Hunt? It helps to discuss with Jessica because not all grant requests are approved. Do you receive any financial aid aside from the Fellowship? Other aid includes federal loans (subsidized and unsubsidized), private loans, Pell grant, National Merit, other outside scholarships. - If in doubt, refer to your financial aid award on OASIS. If yes, please list: SubmissionInstructions Instructions Submission • Please email Emily to set up a submission appointment, as she will need to process additional paperwork that requires your signature. Please bring your paper-clipped (not stapled) application to this appointment or email it to Emily ahead of time. Grant Application Sections 1. 2. 3. 4. Grant Request - For international travel, State Department info can be reviewed at: http://travel.state.gov/ Line-Item Budget Description of Conference or Project and How it Applies to your Educational/ Professional Goals Promissory Note - Requires applicant submit receipts and repay unspent funds; fill out only if you have Pell 5. 6. 7. International Travel Insurance - Only if traveling internationally; $1/day OIE Agreement and Waiver form Supporting Documents - Please attach information from the organization's website regarding the grant Grant or any student loans proposal (conference agenda/project schedule, basic organization/program information, and financial information at minimum). Section 1: Academic Research/Conference Grant Request Form choose one: Type of Grant: __________________________ STUDENT INFORMATION Name: ______________________________________ Student ID number (810): _______________________ Full permanent address: Street address: ___________________________________________________________________ City, State, ZIP: __________________________________________________________________ Cell phone number: _____________________ E-mail address: __________________________________ Class year: ____________ Major(s): ____________________________________________________ CONFERENCE/RESEARCH INFORMATION Conference or Research title: ______________________________________________________________ Website: ______________________________________________________________________________ Location of travel (city, state): _____________________________________________ Lodging information: ____________________________________________________________________ Faculty member overseeing research and/or recommending the conference to you (if applicable): Name: ______________________________ Title: _______________________________ E-mail: ______________________________ Conference/Research date range (mm/dd/yy): __________________________________ Travel date range (if different from above; mm/dd/yy): _________________________________ Requested amount: $ ____________________ (total amount requesting from next page) Financial aid received (other than Foundation Fellowship): ______________________________________ If I am traveling internationally, I acknowledge that I have read and understood the U.S. Department of State’s travel warnings, consular information sheets and/or public announcements regarding the country (ies) I will be visiting. This grant application is not to a country currently under a travel warning. I agree to submit a travel report by September 1 for summer, February 1 for fall or winter or June 1 for spring or May travel. Signature of Applicant: Date: __________________ Foundation Fellows Program use only Approval: David S. Williams Director Date Jessica B. Hunt Scholarships Coordinator Date Section 2: Line-Item Budget Form Guidelines: • Supplies that benefit an organization will not be covered unless included in program fees from that organization. • No bank or credit card fees are covered. • Transportation to Atlanta airport not covered (or whichever airport you fly out of). • No gifts, alcohol, clothes, or paying for other people’s expenses. Student's Name Item # 1 Expense Category (use drop-down menu) Additional Description Amount 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 Total Total Requesting (if less than total above) $ Approval: Jessica B. Hunt $ 0.00 Section 3: Description of Conference/Project and How It Applies to Educational/Professional Goals (Please only use space provided.) The University of Georgia Foundation PROMISSORY NOTE FOR CASH ADVANCE I, , request the sum of from the University of Georgia Foundation. This sum is to be used for the specific purpose(s) stated below from 20-42000 check request : (LIST FUND NUMBER) (LIST BUSINESS PURPOSE INCLUDING LOCATION AND DATES OF TRAVEL) I have read and understand the Policies and Procedures for advances of the University of Georgia Foundation. I agree to submit the appropriate receipts and documents consistent with the Policies and Procedures. If actual costs are less than the amount advanced, I understand I must refund the difference to the Foundation along with any receipts and documents required. I will submit any refund and documentation to the Office of Financial Services in an acceptable form on or before which is the later of 30 days from the issue of the advance or completion of travel or task. I understand and agree that I am personally responsible for the above referenced cash advance. If I default on the payment of this note, or if I fail to comply with this agreement, the Office of Financial Services reserves the right to refuse the issuance of future advances and may take action to retrieve funds from amounts owed by the University of Georgia, possibly including deducting any amount owed from my pay. Requestor Address: (Sign & Date) Requestor Requestor Phone #: Requestor Email: (Sign & Date) V.P./Dean Approval Appointment Request for post-travel Receipt Submission (Emily will confirm via email): Date AND Time #1 Office of Financial Services (Sign & Date) Date AND Time #2 A copy of this note will be provided with the cash advance. _ Section 5: International Travel Insurance (complete only if traveling internationally) Instructions: Submit form with payment along with complete grant application. - You must pay by check, made out to: T.W. Lord & Associates. See travel insurance document (on the “Travel Grant Procedures” page of the FF section of the Honors website) for coverage details. Contact FF office if a claim needs to be submitted at conclusion of travel. Countries of coverage: Official dates of program: You may extend this coverage for up to 8 weeks total before or after your program. Please indicate the dates of insurance coverage you desire (including travel days): Dates of coverage: Total # days x $1 = total cost = If you are off campus at the time of your grant request or will otherwise not be able to pick up your travel insurance ID card, please list the best address for Emily to mail your card (if you are currently on campus, please leave blank): Name: (if not you) Street address: City, State, ZIP: Country: (if not USA) Section 6: OIE Agreement and Waiver Form I, , a participant in a domestic or international activity in hereby agree as follows: I have chosen to engage in . < description of activities> during . I have thoroughly researched this international activity and chosen it freely, independently, and with careful consideration. I acknowledge that the Board of Regents of the University System of Georgia and its agents and employees assume no responsibilities for my safety or any liability for costs or difficulties that I may incur related to the activities I pursue while abroad and I that I participate in these activities at my own risk. In exchange for the opportunity to received funds from the University of Georgia for this activity I hereby release and forever discharge the University of Georgia, the Board of Regents of the University System of Georgia, their members individually and their officers, agents and employees from any and all claims, demands, rights, expenses, actions, and causes of action, of whatever kind, arising from or by reason of any personal injury, bodily injury, property damage, or the consequences thereof, whether foreseeable or not, resulting from or in any way connected with this activity. I further covenant and agree that for the consideration stated above, I will hold forever harmless and will not take legal action against the University of Georgia, the Board of Regents of the University System of Georgia, its members individually, and their officers, agents, and employees for any claim for damages arising or growing out of my participation whether their actions were negligent, willful, or intentional. I certify that I am at least 18 years of age. This consent is given freely and voluntarily by me without coercion, duress, threat or promise of any kind. I certify that I understand and have read the above carefully before signing. I understand that I am not subject to any adverse action if I do not sign. Signature of Student Date Section 7: Supporting Documents Supporting Documents - Please attach information from the organization's website regarding the grant proposal (basic organization/program and financial information at minimum).