Student Travel & Publication Funding Request Form This form is for Research-related travel and/or publications Applicant InformationName* Date of Request*Class Year*Phone*Home Address*Please enter the address where you are currently recieving mail. This information is entered into the travel system so that you can be reimbursed. Street Address Address Line 2 City State AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code Email* Research Mentor InformationMentor Name* Mentor Department*Mentor Email* Letter of Support from Research Mentor*Conference and/or Publication InformationConference and/ or Publication Name*Conference Date(s) or Publication Date*Conference Location ( City and State)*Educational Purpose*Is this event related to a student organization?*YesNoIf yes, which organization?*Are you receiving any additional funding support from a UF division? (For example, is another department paying for any part of this trip).*YesNoIf yes, please provide department name, contact person, and email.*Research Presentation InformationResearch Abstract and/or Poster*Additional Documents (if necessary)Untitled