Collaborative Conference Grant Request

Each quarter Student Chapters may apply for up to $2,500 of funding for collaborative efforts with other SPIE Student Chapters. The purpose of these funds is to facilitate professional development and leadership opportunities at conferences created for students, by students. When filling out the following questions, please focus on clarity and descriptiveness of your answers. Applications are due 1st of January, April, July, & October.You can expect a response about two weeks after the end of the quarter (15th of January, April, July, & October). For full details, visit: SPIE.org/chapterresources.

Reminder:Visiting Lecturer Grants may be used to bring speakers to the conference. Please see details of this program atSPIE.org/vlp.

Requestor Information
Full name of requestor / Your elected position in Chapter
Email address / Contact phone number / SPIE member #

ConferenceContacts

Conference name / Official Language of Conference
Organizing Chapters
Primary conference contacts (include name, role, and contact information):
Names and e-mail addresses of Conference Chairs (if any):

Activity Plan

Conference title:
  • Purpose of meeting:
  • Conference technical topic(s):
  • Professional development program plan:
  • How will you promote student interaction?
  • What is your marketing plan to advertise this conference?
  • How would you like SPIE to be involved with your conference?

Date and location of Conference:
Conference Registration Deadline(s): / Target audience, anticipated size, and country of study:

Budget & Financial Support

Include budget information for the conference including hotel, food, facilities, equipment, and speaker fees & any revenue collected (registration fees, course fees, etc).
Additional support (source & amount): / Total amount requested from SPIE:
Are you planning to use your Visiting Lecturer Funding?
Full bank name, address, name on account, IBAN account number (or SWIFT if IBAN not available), and Chapter mailing address,
OR “Make check payable to” and mailing address:
(Unless you have a way to convert a check in US funds drawn from a US bank, you must provide complete banking information.)

Signatures

Signature of requestor / Date
Signature of advisor / Date

Send application to: Dirk Fabian, SPIE Student Services Coordinator

Fax: +1 360 647 1445

OR

Benjamyn Lockwood, SPIE Student Activity Coordinator

Fax: +1 360 647 1445