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Student Academic Development Application

Use the StAD Guidelines and Rubric to gather information to complete this form. DO NOT begin the application form without reviewing the required proposal and cost estimation document guidelines – you will not be able to successfully complete this form without it.

Application deadlines are:
• Last Friday in Oct. for activities taking place between July 1 and December 31
• Last Friday March for activities taking place between January 1 and June 30

If you are traveling out of the country for your activity you must contact Eileen Rucki, Director of International Education, by either email, rucki@findlay.edu, or phone, 419.434.5991, to complete some paperwork before you travel.

Student Information

Full Name *

Student ID *

Email *

Phone *

Address *

City *

State

Zip *

Classification *

At least 12 hours per semester?

College *

Major *

Activity Information

Event Name *

Begin Date *

End Date *

City

State

Specify your own value:

Country

Author Role

If you are the only author of your presentation, select Individual

If you are in a Group, pick the order you will be listed on the presentation

Author Preparation

Describe the presentation structure, who is responsible for preparing the content, and how long you will speak during the presentation.

Type of Participation

Select Present if you are speaking

Select Participate if you are working on an activity, contest, or workshop but not a formal presentation

Select Attend if you are not presenting or participating in any other way

Is the research work part of an approved IRB protocol? *

IRB Protocol Number

Is the research work part of an approved IACUC protocol? *

IACUC Protocol Number

Proposal and Cost Documentation

Gather the following information and provide all information for submission. Be sure to review the Student Academic Development Guidelines and Rubric to help you prepare the file correctly.

Presentation Title

Enter NA if attending or list activity, contest, or workshop if participating

Activity Description

In your own words, explain what activity you will attend. As specifically as possible, explain what sessions or workshops you plan to attend. NOTE: See the activity description section of the rubric to understand how this element of your application will be evaluated.

Activity Rationale

Describe how this activity connects to your discipline. As specifically as possible, list what you hope to learn at the event and how you will apply this to your academic and/or professional growth. NOTE: See the activity rationale section of the rubric to understand how this element of your application will be evaluated.

Post Activity Sharing

Please give as detailed description as possible of how you will share about information gained from this activity. As specifically as possible, list who you will share with, when you will share, and what main message you will deliver. NOTE: See the post activity sharing section of the rubric to understand how this element of your application will be evaluated.
*

Cost Estimates

NOTE: When entering amounts, please use numbers only. No dollar signs.

Using the information provided in the Student Academic Development Guidelines and Rubric identify and document the best estimated costs for the categories that follow. See the Guidelines and Rubric for assistance in correctly estimating expenses.

Registration Cost *

Travel Cost *

Hotel Cost *

Meal Cost *

Other Costs *

Total Cost

NOTE this will automatically calculate if you only enter numbers above (no dollar signs)

Attachments

In a single PDF provide all necessary documentation related to the activity. Be sure to review the Student Academic Development Guidelines and Rubric to help you prepare the file correctly. NOTE: All costs must be shown even if these exceed the $500 annual cap.

Acceptance: Provide letter or email if presenting. If acceptance is not final, provide proof of submission.
Travel: Document costs appropriate to transportation (car mileage, airfare, buses, taxies, public transportation, etc.).
Food: Document expenses using a per diem estimator to give as accurate a figure as possible (https://www.gsa.gov/portal/category/100120, use the FINAL column labeled M&IE multiplied by the days you will be at the event)
Lodging: Document only your share of costs if sharing rooms with other participants (total of room divided by occupant number)
Other: Document any expenses required for the activity not covered in other areas
Faculty Endorsement Form: Request a sponsoring faculty member fill out the Faculty Endorsement Form. The proposal will not be considered without a complete Faculty Endorsement Form, it is the student's responsibility to return this form with the application information.
Note: Faculty may complete just one Faculty Endorsement Form to endorse a group of students who are participating in the same conference or workshop—provided, of course, that all students' names are listed on the Endorsement Form. Faculty must send an electronic copy to ALL students' listed on the form.

Attachments

Submit in a SINGLE PDF. Request assistance from sponsoring faculty as needed for scanning into PDF document.

Add Attachment

*I have carefully read the Student Academic Development Guidelines. I understand that I must submit a detailed evaluation of the event I attended and submit an expense report (with attached receipts) within the timeframe outlined in the Student Academic Development Guidelines. I understand that if I do not use these funds for their intended purpose and/or do not provide receipts and/or do not complete the evaluation and expense reports in a timely fashion, I will not receive Student Academic Development funding.

Signature:
Note: You can “sign" this form by typing your name on the signature line.