SUNY ORANGE CONFERENCE FUNDING REQUEST

Date:______________________

 To be filled
out by
Applicant

	(Please Type/Print)
Applicant’s Name :_____________________________________Ext.  #:_____________

Dept/Area____________________Are you Faculty, Staff, Civil Service or Grant Funded?

Are you full time?_________________         Part time?___________________

If grant funded, when did you start working at the College in that capacity?____________

Conference Title:__________________________________________________________

Place? ___________________________        Date: ______________________________

Description of Conference: _________________________________________________

How will your presentation/attendance benefit the college and you professionally?
___________________________________________________________________
___________________________________________________________________

Applicant’s signature: ________________________________________

To be filled out
By Dept. Chair

Approval by Department Chair/Area Approval:__________________________________

Amount of funding provided by Department or Area: ____________________________	

	
IF FULLY FUNDED BY DEPARTMENT, AVP/VP SIGNATURES ARE NOT NECESSARY.  SKIP TO INSTRUCTIONS.

To be filled                   out by
AVP or VP

	
Amount of funding granted by AVP or VP:________________.

Explanation:_______________________________________________________________

AVP or VP Signature:_______________________________________________________	

INSTRUCTIONS:  
1.  Fill out form make sure to get all required signatures..
2.  Send copies to each person who signed this form including yourself.
3. Send an additional copy to MaryAnn VanBenschoten, Chair of FSDC.