ZEAL Project Dissemination Travel Grant Application 
Please complete this entire application to be considered for this award. The maximum amount of each grant award is $500.  We recommend preparing written materials in a Word document and saving them before copying and pasting written narratives into the application. 
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Full name *
Mailing address *
Email address *
Phone number *
Current position or student *
If student: program name & expected completion date
Amount requested (note $500 maximum award) *
Title of your professional/academic presentation *
Date of presentation *
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/
DD
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Type of presentation *
Name of conference you will attend *
Conference sponsor *
Name/s of co-presenters (if any)
List conference expenses you are requesting grant award to cover (you may list expenses exceeding $500 max grant award) *
Are you receiving other travel funding for this conference?  *
If you are receiving other travel forms, please describe amounts and what expenses they will cover *
Please type your name below in acknowledgement of the following three statements:
1. The information included in this application is correct to the best of my knowledge
2. If I am approved for an award, I understand that I must submit your presentation acceptance letter/email, proof of attendance, and a one paragraph summary of the conference to the Zeta Eta at-Large Chapter Treasurer to receive reimbursement. The Treasurer will reimburse expenses after receipt of proof of attendance and presentation summary is received.
3. I agree that my presentation summary may be published in the Zeta Eta at-Large Chapter newsletter.
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