OU Travel Grant Form

Starting in 2018, the Foundation provided grants to 6 students totaling $4,000.00 for its first year of operations. For 2019 we have plans to double the budget, expand into fall and winter conferences and hope to provide double the grants.

In 2019 we gave out 13 grants totaling $3,800.00, and we plan on doubling that total before the end of this year.

       Applicant's Name

    First Name Middle Name Last Name
       
             

       Contact Information

    Street Address *   Address Line 2
     

    City *   State / Province / Region *   ZIP / Postal Code *   Country *
         

    Primary Phone Number * Applicant's Work Phone Applicant's Email *
       
             

       Academic Information

    Academic Year *   Graduation Year *   Graduation Season *
       
             
    If Other   If Other    
         

    Major in Psychology at Oakland University? *   Academic Status: *
     
         
        If Other
       

    Faculty Mentor:
     
    Name of The Lab That You Are Participating in and Describe Your Role: *
     

       Event Information

    Event Name * Event Location: * Event Date: *
       

    First Time Attending the Event? *   Presenting? *
     
         

       Estimated Financial Assistance You Are Requesting:

     
    The items requested may include, but are not limited to:

    -Airfare
    -Lodging
    -Car and/or Local Transportation during event
    -Event registration or membership fees
    -Costs such as poster/handout printing
     

    Travel $ Lodging $ Registration $
       

    Additional Expenses $   Total $ Assistance Requesting:
     

     
    Note
    Reward recipients will be required to submit receipts for all expenses incurred, as well as, proof of event attendance in order to receive financial reimbursement.
     

       Grant Application History:
     
    Have you applied for or do you plan to apply for another grant for this event? If Yes:*
     

    Name of Grant Dollar Amount Requested Status of Grant (Approved, Declined, Pending)
       

     
    Note
    Note: If receiving funds from other grants, applicants will still be eligible for the SJS Travel Grant.
     
    Have You Applied Previously for an SJS Travel Grant? *
     
    Please Describe: (I) Why You Would Like to Attend This Event, (II) What You Hope to Gain From This Event, and (III) Your Career Aspirations: *
    Include any background information, such any obstacles or experiences that you have had to overcome or that have helped you achieve your goals. Additionally, we would like to hear about any experiences with statistics and how statistics influences your work in the lab (if applicable).

       Faculty Recommendation:

    A Faculty member agrees to submit a recommendation letter to the Shelby Jane Seyburn Foundation on your behalf.
         
    Faculty recommendations will be submitted online. A link will be emailed directly to requested Faculty member.
     
    Faculty Member First Name   Faculty Member Last Name
     
         
    Faculty Member Email    
       
         
         
         
    Terms & Conditions
     
    I understand that I may be asked to provide a written or recorded video testimonial and/or present or share my conference experience at the SJS Second Annual Golf Outing on July 22nd, 2019 upon request.
    I Agree

         
      Your Signature *  
     
    		 
         
       

    Faculty statements of support must be uploaded by 11:59 PM on the day of the application deadline to be included in the application. Faculty will not receive an email request to upload their statements until the application is submitted by the applicant. To allow time for your faculty recommender to submit their statement of support, plan on submitting your application ahead of the deadline.