Request for BYU-Idaho Jacob Spori Stipend                                               

 

Name of Sponsoring Student Academic Society: ____________________________ Date:  _____

 

Student Seeking Funds: (full name):_____________________________      Phone:  ___________

   (If more than student, please attach a separate sheet with a list of names and class standing)

 

Class standing:              [  ]  Freshman          [  ]  Sophomore        [  ]  Junior            [  ]  Senior

 

 

Conference information (name, location, dates):________________________________________

___________________________________________________________________________

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Describe in detail your involvement in the conference:___________________________________

___________________________________________________________________________

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Anticipated Expenses:

     Travel:                                               $__________

     Lodging:                                           $__________

     Food:                                                 $__________

     Conference Registration:               $__________

     TOTAL:                                            $__________

 

 

Other Funding Sources:

     Self:                                   $__________

     Society:                                             $__________

     Department or College:                  $__________

     Other:                                                $__________

 

 

Amount Requested (generally $200 per person maximum) : $_______________

    

We certify that the students requesting these funds are active members of our academic society whose participation in this conference is as described above.

 

Society President:__________________________________       Date:____________________

 

Faculty Advisor:                 

 

Date: