OI Travel Funding Request Form

Name

First

Last

Position

Faculty advisor (students only)

Date

Email

Name of Conference

Date of Conference

Location of Conference

Purpose for attending conference

Cost to attend. Include cost of each if applicable: travel, lodging, registration, meals (not to exceed per diem) and total expenses.

Amount requested from OI (Maximum $500)

Abstract Submission (email documentation to obesity@uga.edu when form is submitted)

Signature

Comments/Notes