REGION XII NATIONAL CONFERENCE

REGISTRATION FEE GRANT APPLICATION

Deadline: April 22nd, 2011

Name: ______NAFSA Member #: ______

Institution: ______Title: ______

Mailing Address: ______


Email: ______Telephone: ______

Funds Available to Traveler

From Home Institution / $
From Personal Contribution / $
Other source: ______/ $
Total Personal/Institutional Funds / $
Total Expenses / $

Required Documents

·  Registration Fee Grant Application form

·  Statement of Objectives – this statement should highlight the nature of your work in international education and what you hope to achieve by participating in the regional conference.

·  Letter of Recommendation – Provide a letter from your supervisor, program coordinator or student advisor which includes his/her support of your attendance at the conference as well as your contribution to international educational exchange at your institution/organization. The letter must also indicate any financial support that your institution or organization is providing.

Conditions of Awards

Recipients must:

·  Attend the entire conference.

·  Submit a Registration Fee Grant Reimbursement Claim, post conference, including original receipt for your conference basic registration fee, to the Region XII Business Manager for recipient’s reimbursement by June 30, 2011, no exceptions.

Name/Title of Recommender: ______

Signature of Applicant: ______Date: ______

Please send the application with required paperwork to your District Chair as follows by Friday, April 22, 2011:

Hawaii District:

Roger Fong
Center Director - HNL
ELS Language Centers/Honolulu Hawaii Pacific University
1188 Fort Street
Honolulu, HI 96813-2713
Phone: 808-543-8075
Fax: 808-543-8073
Email:

Northern District (All of Northern California north and east of Santa Barbara County line plus Northern Nevada):

Inna Zaltsmann
Immigration Advisor
Independent Consultant
7189 Blue Hill Drive
San Jose, CA 95129-3622
Tel: 408.219.4886
Fax: 408.996.7776

Southern District (All of Southern California including Santa Barbara County and all area south and east of it plus Southern Nevada):

Donald Delgado Director
International Place of The Claremont Colleges
390 E. 9th Street
Claremont CA 91711
Telephone: 909.607.7868
Email: