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Student Travel Grant Application $SSOLFDWLRQ'DWH 63,(,'1RU0HPEHU1XPEHU Return to: SPIE Conference Programs and Proceedings Dept. PO Box 10, Bellingham, WA 98227-0010 USA Fax Number: 1 360 647 1445 Email: See Conference Program Coordinator Contact List     SPIE Student Travel Grants are available for full-time students only Grants are intended to partially cover travel expenses (e.g. airfare, hotel; excludes meals and conference registration fees) Grants are typically $250-$500 USD per domestic traveler and $300-$750 USD per international traveler, but may be less GRANT PAYMENTS: Keep your travel receipts for reimbursement. You will be reimbursed by check after the meeting; reimbursements will not exceed the total amount on your submitted receipts. To qualify, you must: be a full-time student (post-doctoral students do not qualify) who will present an accepted paper at the conference not have received SPIE funding in the past 12 months attach a letter of recommendation from your faculty advisor or the head of your department submit this application form and other required documents no later than 10 weeks prior to the 1st day of the event* *See SPIE Conferences + Exhibitions Calendar to confirm first day of event; late applications will NOT be considered Presentation Information Event/Symposium Title &RQIHUHQFH7LWOH 63,(3DSHU1XPEHU 63,(3DSHU7LWOH Student Information Full Name /DVW )DPLO\6XUQDPH )LUVW *LYHQ 0, 1DPHRI$FDGHPLF,QVWLWXWLRQ Academic Institution 'HSDUWPHQW Information )LHOG$UHDRI6WXG\ /HYHORI6WXG\ XQGHUJUDGJUDGXDWH  Mailing Address 'HJUHH6RXJKW %6063K'HWF  6WUHHW$GGUHVV Select One: Home &LW\ Academic Institution Contact 3KRQH Information $QWLFLSDWHG*UDGXDWLRQ'DWH 'HSWRU$SDUWPHQW8QLW 6WDWH 3RVWDO&RGH &RXQWU\ (PDLO Estimated Expenses If you will share travel expenses with someone else, claim only your share. Expenses for meals and conference registration will not be reimbursed. Research economical lodging options. There are often budget hotels and hostels in the area. Traveling from (City) Traveling to (City) Travel $0 Number of hotel nights Price per night Lodging $ 0 Total $ 0 Page 1 Student Travel Grant Application Grant Qualifications Are you a full-time student? YES NO Have you ever received SPIE funding to attend an SPIE meeting? YES NO Are you otherwise employed? YES NO Are you the presenter of this paper? YES NO ,I\HVOLVW\HDUDQGW\SHRIIXQGLQJ VWXGHQWJUDQWIHHZDLYHU  ,IHPSOR\HGKRZ" 3OHDVHOLVW\RXURWKHUVRXUFHVRIIXQGLQJDQGKRZWKLVJUDQWZRXOGKHOS\RXDWWHQGWKHPHHWLQJ %ULHIO\VWDWHEHORZKRZ\RXH[SHFWWREHQHILWE\DWWHQGLQJWKLVFRQIHUHQFH Faculty Advisor Information Full Name /DVW )DPLO\6XUQDPH  )LUVW *LYHQ  6WUHHW$GGUHVV Mailing Address &LW\ Contact 3KRQH Information 0, 'HSDUWPHQW 6WDWH 3RVWDO&RGH &RXQWU\ (PDLO Signatures I certify that this information is true and complete to the best of my knowledge. 'DWH Student Signature I certify that our institution is unable to provide full funding for the applicant to attend the stated meeting. Faculty Advisor 'DWH Signature REQUIRED Attachment Attach a letter of recommendation from your faculty advisor or the head of your department. Return Application to SPIE prior to Deadline By Email: By Mail: By Fax: Select Conference Program Coordinator from Contact List SPIE Conference Programs and Proceedings Dept. PO Box 10 Bellingham, WA 98227-0010 USA +1 360 647 1445 Page 2