Fillable 2EPICTS Application Form Aug2018 (Jacksonville University)

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2EPICTS Application Form Aug2018 (Jacksonville University)

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ORSP: TS – EPIC Professional Development Application - V. 8/22/2018
2018-2019 Travel Support
EPIC - Professional Development
Application Form
Instructions: Please be sure to read the Travel Support EPIC Professional Development
Guidelines posted on the ORSP webpage. Complete this fillable form and forward along with any required
attachments to EPIC@ju.edu before 5:00 pm EST on the second Monday of the month. Travel
Support requests must be submitted at least four (4) weeks prior to the departure date, and six weeks
prior if traveling out-of-state. Award decisions are returned no later than the last day of the month the
request was submitted. However, any proposal received after a deadline listed below will be considered
during the following month’s cycle.
2018 Deadlines: September 10 October 8 (Tuesday) November 13* December 10
*Monday, Nov 12 is Veterans’ Day
2019 Deadlines: January 14 February 11 March 11 April 8 May 13 June 10
I. Travel Support Request
Participation Purpose (check one): Attendee Presenter
II. Faculty/Student Information
Name: Academic Rank/Year:
Department/Major:
JU Email:
Signature of Applicant:
III. Travel Details
Conference
Title
Presentation
Title
, if applicable
Destination
Dates of
Conference
Start Date
End
Date
Departure
Date
Return
Date
Amount of
Funding
Requested*
$1,000 for attending $1,500 for presenting
Original receipts required for reimbursement.
Electronic signatures indicate review & approval. Note - the form cannot be altered once digitally signed.
Division Chair:
Required Attachments: Attendee applicants submit completed form and the conference agenda (PDF,
screenshots, etc., but please no links). Presenter applicants submit completed form and presentation
abstract. For reimbursement, all awardees must submit original receipts, a copy of the conference program
and, if they presented, evidence of acceptance via letter/email. If traveling out of state, the FDOE
request for approval form must be attached.
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2EPICTS Application Form Aug2018 (Jacksonville University)

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Completed 23 July 2020

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