ALBANY STATE UNIVERSITY
O
FFICE OF RESEARCH AND SPONSORED PROGRAMS
TECHNICAL ASSISTANCE WORKSHOP
APPLICATION FORM
Date Submitted:
__________________
Applicant’s Name:
_________________________________________________________________
Department:
___________________________
Office Location:
_____________________
Office Phone:
___________________________
Cell Phone:
_____________________
Hosting Agency Contact Info:
________________________________________________________
Funding Agency Contact Info:
________________________________________________________
Title of Workshop:
_____________________________________________________________
Dates of Workshop:
_____________________________________________________________
Location of Workshop:
__________________________________________________________
Estimated Cost:
______________________________________________________________
The application packet must include the following: (to be submitted to ORSP - ACAD, Room 383)
A letter of interest
A statement briefly describing the advantages/outcomes, benefits to ASU and the attendee
A budget detailing all the costs involved in attending the workshop
An endorsement letter from your immediate supervisor (Chair, Dean, etc.)
The below signed contract
All applications must be submitted at least three (3) weeks prior to the date of the workshop.
CONTRACT
________________________________________
I
Insert your name
hereby certify that if awarded the travel funds, I will
submit a proposal to the funding agency in response to the announcement no later than six months after the
completion of the technical assistance workshop. I further understand that if I fail to submit a proposal I will
be required to repay the total amount awarded.
__________________________________________________ _______________
Applicant Signature Date
Disclaimer:
We will make every effort to approve applicants; however, the sub
mission of a request does not automatically obligate the Office of Research and Sponsored
Programs, as approval is based on the availability of funds.
Official Use Only
Approved Denied
_____________________________________ _____________
Signature Date