Usf Worldfacultytravel Mobility Grantapplication Form

USF WORLDFACULTYTRAVEL MOBILITY GRANTAPPLICATION FORM

Please submit the completed application form and supporting documents to:

USF World, CGS-101

Attn: Faculty Travel Mobility Grant ProgramApplications are due by 5:00pm, November 14, 2014

Submit to:

1. RESEARCHER DETAILS

Name:

GEMS ID:

Rank at USF:

Department or School:

Applicant’s USF address:

Telephone no:

Email:

2. PARTNER DETAILS

Host institution: (Name and Location)

Host contact:

Host contact position/job title:

Host contact professional address:

Telephone No:

Email:

Please provide a brief summary of any research and academic links which already exist between your department/school and the department/school at the partner institution
* MAXIMUM 500 WORDS

3. REQUESTED FUNDING (max $2,500) – Budget feasibility will be evaluated

Item / Detail / Sub-total
Visa
Insurance / NOTE:
USF Education Abroad provides low cost emergency evacuation insurance for international travel $50.00 per month
Choose:Travel Registration & Insurance link
Airfare
Transportation / (To and from airport, ground transport at host location)
Accommodation
Food Per Diem / Travel
Domestic per diem $______
International (by location): $______
Other (please explain)
Total

4. ADDITIONAL SOURCES OF SUPPORT

Source

/ Status of funds (confirmed or pending) / Sub-total
Total

5. PROJECT STATEMENT

MAXIMUM OF 1000 WORDS ~ 12 PT FONT ~ 1” MARGINS ~ DOUBLE SPACED
(a)Summary of project you intend to undertake, detailing proposed interactions with the partner institution
(b)Anticipated benefits of the award, both for your professional development and for each of the partner universities
(c)Any exceptional expertise or facilities available to you through this visit
(d)How you and your department/school propose to sustain project relationships built through your visit

6. STATEMENT OF INTENDED OUTCOMES

PLEASE ATTACH A SEPARATE STATEMENTNOT TO EXCEED ONE PAGE~12 PT FONT ~ 1” MARGINS ~ DOUBLE SPACED

Successful applications must include a statement of expected project outcomes that serve to strengthen the institutional partnership. In addition, awardees are required to submit a Final Report within 90 days of the project end date. Aspects of this report may be made available to a wider audience via the USF World website.

7. SUPPORTING STATEMENT FROM DEPARTMENT CHAIR

This statement should explain the benefits to you and your department/school and should indicate how the relationships built will be sustained after the visit.

Please print department chair’s name
Email address

8. LETTER OF INVITATION/SUPPORT FROM HOST INSTITUTION (Email communication is accepted)

Please print contact’s name
Email address

9. ACCOMPANYING DOCUMENT CHECKLIST:

1000 Word statement describing the project

Statement of intended outcomes

Supporting statement/letter from department chair

Letter of invitation/support from host institution

Abbreviated C.V. (not to exceed 3 pages)

Evidence of matching support

(If applicable)

10. APPLICANT DECLARATION

If successful in being awarded a FacultyTravel Mobility Grant by USF World, I will observe the terms and conditions set forth in the application guidelines. I agree to submit a Final Report to USF World no later than 90 days after international travel has concluded. I agree to inform USF World of outcomes generated from the project beyond the grant period.
Applicant’s Signature: / Date:
Chair or Unit Head’s Signature: / Date:
Dean’s Signature: / Date: