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IRACDA Materials & Supplies Request Form
Please complete the form below to request approval for teaching and other supplies related to your career and professional development. Total not to exceed $2,000 per year.
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* Indicates required question
Email
*
Your email
IRACDA Scholar Information
First Name
*
Your answer
Last Name
*
Your answer
Academic Department
*
Your answer
Current Research Mentor
*
Your answer
Budget Outline
Enter the total dollar amount being requested for the items listed below.
Supplies Needed
Please briefly describe the items you wish to purchase along with the cost per item.
Your answer
Training/Course
Briefly describe the course you would like to attend or professional training you would like receive.
Your answer
Course/Training Fee
Your answer
Course/Training Start Date
MM
/
DD
/
YYYY
Course/Training End Date
MM
/
DD
/
YYYY
Course/Training Location
City, State
Your answer
Course/Training Lodging Cost
Your answer
Course/Training Transportation Cost
Your answer
Mode of Transportation
Your answer
Miscellaneous Costs for Course/Training
(e.g. parking, ground transportation, etc.)
Your answer
Total Funding Requested
*
Indicate the grand total of funding being requested including fees, travel, lodging & miscellaneous costs.
Your answer
Purpose Statement
Briefly describe how this purchase or training and other supplies will support your career/professional development as a scholar and STEM professional.
*
Your answer
Verification
I hereby affirm that the information contained in this application is true to the best of my knowledge. If awarded this IRACDA grant, I will adhere to state mandated financial guidelines pertaining to expenses I incur for reimbursement.
Full Name
*
Your answer
A copy of your responses will be emailed to the address you provided.
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