Applicant Contact Information
First Name: 
Last Name:
Address:
City:
State:
Zip:
Telephone:
Email:

Affiliation Information
University/College/Place of Employment:
Department:
Street Address/PO Box:
City:
State:
Zip:
Telephone:
Fax:
Name of Advisor/Sponsor:
Email of Advisor/Sponsor:

Details of Proposed Travel
This grant covers the cost of conference registration, accommodations, and travel. Upon grant approval, the Simon Foundation will make conference registration and accommodation arrangements. However, the award recipient will be required to make his or her own travel arrangements, with future reimbursement of expenses. Please outline the details of your proposed travel arrangements below.

Departure Date:
Return Date:

Proposed Method of Transportation
Please select the listed method(s) of transportation (private vehicle, rented vehicle, bus, train, or air) and then fill out the corresponding details. If using more than one method of transportation (such as air, and then a rented vehicle or train to the hotel site), please fill out the details for each method.

Private vehicle
Mileage: x $0.445 per mile
reimbursement rate = total mileage reimbursement

Rented Vehicle
Rental Rate:

Bus
Bus Rate:

Train
Train Rate:

Air
Air Rate:

Other
Specify:
Cost:

Estimated Total Travel Costs:

Your application will not be processed until the Applicant's Letter and the Advisor's Letter have been received. Please email completed letters to application@simonfoundation.org