Early Career Participants Support Application for Geocomputation 2015
/Contact Information
Name / PositionInstitution
Street Address
City ST ZIP Code
Country
E-Mail Address / Phone
Eligibility
Are you a graduate student? / ___ Master’s / ___ PhD / ___ NoDid you receive a PhD within the last 5 years (i.e., after May 22th, 2010)? / ___ Yes / ___ No
If Yes,granting institution: ______/ Date: ______
Will you present a paper or a poster at Geocomputation 2015? / ___ Yes / ___ No
For what did you register?
/ ___ Conference / ___ WorkshopRequirements
______(initial) / I agree to respond in a timely fashion to a survey that is designed to evaluate the impact of this conference attendance grant, ifthis grant is awarded.This survey is scheduled to be sent out in November, 2015.______(initial) / Anyfunds awarded requireme to submit receipts in a timely fashion after the conference ends to get reimbursed for eligible expenses.Upon availability of funds, this award supports up to $500 in eligible expenses for an awardee from the United States or Canada, and up to $ 750 for an awardee from other counties.
______(initial) / If I am an awardee from the local (i.e., Dallas-Ft. Worth) area, I am eligible to get reimbursed only for the conference and workshop registration fees.
______(initial) / If I am an awardee who registers for a workshop but not for the conference, I will be eligible to be reimbursed only for the workshop registration fee (i.e., no travel support).
Agreement and Signature
By submitting this application, I affirm that the facts set forth in it are true and complete. I understand that if I am awardedaconference attendance grant, any false statements, omissions, or other misrepresentations made by me on this application form may result in my immediate forfeiture of my award.In addition, I will forfeit my award if I do not deliver my presentation.
Name (printed)Signature / Date