ࡱ> OQNe 5bjbj^^ >44< < LDXFFFF!.Ok!!!!!!$ #Eu{!!{{EFF{ FF{FA 0f$f$f$|{{{{{{{EE{{{{{{{f${{{{{{{{{< > z: Department of Psychology, University of Toledo Request for Travel ReimbursementNotes: a) The department is committed to providing travel funding to students presenting at professional conferences to support professional development. Each year (pending any yearly budgetary restrictions), the department intends to commit from $200-400 of travel funding to any 1st-5th year in-house graduate student who is a first author and presenter of a paper or poster at a research conference. Additional travel funds to support greater expenses, presenting at a second conference, attending a first conference as a co-author on a presentation, and/or presenting at a first conference for clinical students on internship may be available on a competitive basis; interested students should submit the Department of Psychology Competitive Travel Award Application to receive these additional funds. b) This form along with the abstract of your paper/poster and a copy of the conference booklet (just the pages where your name is printed) must be submitted to the department administrative assistant and chair no less than two weeks in advance of the conference date. c) A travel and expense report with all accompanying receipts and documentation must be submitted within the first month of return from the conference. Failure to abide by this deadline will result in revocation of approved funds. d) Double dipping (i.e. submitting the same expense to two different funding sources OR submitting the same expense for two different individuals) is not allowed. Departmental funds can only be used to cover allowable expenses that have not been covered by other sources. Students receiving funding from other sources must indicate the amount of additional funding, and the requested amount from the department cannot exceed the total amount of allowed expenses minus the additional funds. Please fill in the details as accurately and legibly as possible. Todays Date:  FORMTEXT       Student Name:  FORMTEXT       Email Address:  FORMTEXT       Year in Graduate Program:  FORMTEXT       Specialization (check one): ( Clinical ( Experimental (Specify area:  FORMTEXT       ) Conference Details Name of Conference:  FORMTEXT       Location of Conference:  FORMTEXT      Date of Conference:  FORMTEXT       Presentation Type (check one): ( Paper ( Poster Title and short description of your paper/poster: Check one box: ( First conference, presenter, 1st-5th year in-house student ( Second conference, presenter, 1st-5th year in-house student* ( First conference, presenter, clinical student on internship* ( First conference, co-author, 1st-5th year in-house student* *Requires supplemental application  FORMTEXT       Budget Details (Precise expense amounts & descriptions for all allowable eOPQ[jC H I J L P Q [ c i k m o q    $ <  ôyly\\MMMh8vhCJOJQJaJh8vh0YHCJH*OJQJaJhE5CJOJQJaJh8vh0YH5CJOJQJaJh8vh|4*5CJOJQJaJhECJOJQJaJh8vh0YHCJOJQJaJh8vh|4*CJOJQJaJh8vhCJOJQJaJ hh#hh5B*OJQJ\ph'hh5B*CJOJQJ\ph/PQXw l Wf_UKKK $a$gd $a$gd|4*gdkd$$Iflr))  t 6` 0)644 lap yt$d$&`#$/Ifa$gd  H T v w & I V Y ^ _  J k l  TVWXʻٻٻٻ٠wj`jWh5OJQJh|4*CJOJQJhm/phCJOJQJhhOJQJh8vha~RCJOJQJaJh8vh8vCJOJQJaJh8vh^CJOJQJaJhNCJOJQJaJh8vhCJOJQJaJh8vh|4*CJOJQJaJh8vhCJOJQJaJh` xCJOJQJaJhECJOJQJaJWX>|Xdgd|4*gdNxdgdgddgdxgd|4*gdYDdgd dYDdgd dYDdgd|4* ddgd dgd|4*6:<>⸩󠕉ʱՉH<hMhM5OJQJhMOJQJhOJQJmHnHu"jhOJQJUmHnHu#j)hz'hOJQJUhOJQJjhOJQJUh4hOJQJh5OJQJh5OJQJmHnHu+jh[h5OJQJUmHnHu&jhz'h5OJQJU jh[h5OJQJUh[h5OJQJ$0468LNPXprtz|곪o]P]ⳞB joh4hOJQJhOJQJmHnHu"jhOJQJUmHnHu#jhz'hOJQJUhOJQJjhOJQJUh5OJQJh4h5OJQJhr5OJQJh4hOJQJ"jhMOJQJUmHnHu#jhz'hMOJQJUhMOJQJjhMOJQJUhM5OJQJ024:nrtPTVӯ߄ӯrӯ`#jhz'hOJQJU#jmhz'hOJQJU#jhz'hOJQJUh4h5OJQJhOJQJmHnHu"jhOJQJUmHnHu#jhz'hOJQJUjhOJQJUhOJQJ joh4hOJQJh4hOJQJ%46DFVXZ./78AOQSUpqɳɫ~~~~pp~~ joh4hNOJQJhNhNH*OJQJ joh4h|4*OJQJh4hNOJQJhNOJQJhOJQJ joh4hOJQJh|4*OJQJh4hOJQJhOJQJmHnHu"jhOJQJUmHnHujhOJQJU,^fhjlxz000111-1ٵrrrprr`Uh|4*hOJQJh|4*h|4*5CJOJQJaJUh8vha~RCJOJQJaJh8vhCJOJQJaJh8vh5CJOJQJaJhOJQJhmrOJQJmHnHu"jhmrOJQJUmHnHu#jUhz'hmrOJQJUjhmrOJQJUhmrOJQJhNOJQJh4h|4*OJQJl112L22 3 333404$d$Ifa$gdxgdgdr dgd|4*gdgdmr xpenses are required. Failure to provide expense amounts will result in rejection of the request. Allowable expenses include transportation, lodging (please specify the total amount of lodging costs per person, rather than the overall lodging costs), and conference registration. Transportation: $  FORMTEXT       Lodging: $  FORMTEXT       Conference Registration: $  FORMTEXT       Total Expenses: $  FORMTEXT       Other Funding Sources (List other sources from which funds have been solicited to support this travel request) #Name of other Funding SourceAmount received/anticipated12 Total =$  For Office Use only Request Status: ( Accepted ( Rejected (Reason: ____________________________________________) Approved Amount: $ ________ Signature of the Department Chair: ________________________ Date: _________________________ -1.181912 2 2$2&2:2<2>2H2J2L2z22222222222222222夊~sdsRd#jh|4*hrOJQJUjh|4*hrOJQJUh|4*hrOJQJhrhr5OJQJh8vOJQJ#jh|4*hOJQJUhrOJQJ#j3h|4*hOJQJU(jh|4*hOJQJUmHnHu#jh|4*hOJQJUh|4*hOJQJjh|4*hOJQJU233 3 363304145464:4;4444444444555˿xjj johhOJQJhh5>*OJQJhEOJQJhOJQJhhOJQJ hhhh5OJQJh4hOJQJh1>h5OJQJh5OJQJh|4*hrOJQJjh|4*hrOJQJU"jhrOJQJUmHnHu0414344454\NNNd$Ifgdkd$$IflF'  t06    44 lalpyt54648494:4\NNNd$IfgdkdO$$IflF'  t06    44 lalpyt:4;4<444\NNNd$Ifgdkd$$IflF'  t06    44 lalpyt44444\UU>dx$ld&`#$/Ifgdgdkd$$Ifl+F'  t06    44 lalpyt43545k5l5555WPgdzkd $$IflL)) t 6`ld0)644 lap ytd$ld&`#$/Ifgd{d$ld&`#$/Ifgd<P1h:p/ =!"#$% Dp$$If!vh#v):V l  t 6` 0)65)/ p yttDText1tDText2tDText2tDText2tDText2tDText2tDText2tDText2tDText2jDtDText2tDText2tDText2$$Ifl!vh#v#v #v:V l t0655 5alpyt$$Ifl!vh#v#v #v:V l t0655 5alpyt$$Ifl!vh#v#v #v:V l t0655 5alpyt$$Ifl!vh#v#v #v:V l+ t0655 5alpyt$$If!vh#v):V lL t 6`ld0)65)/ p yt s666666666vvvvvvvvv666666>6666666666666666666666666666666666666666666666666hH6666666666666666666666666666666666666666666666666666666666666666666866666662 0@P`p2( 0@P`p 0@P`p 0@P`p 0@P`p 0@P`p(8HX`~ 0@ 0@ 0@ 0@ 0@ 0@ 0@ 0@ 0@ 0@ 0@ 0@ 0@ 0@ OJPJQJ_HmH nH sH tH N`N Normal dCJPJ_H aJmH sH tH DA D Default Paragraph FontRi@R  Table Normal4 l4a (k (No List ~~ { Table Grid7:V0PJ_H mH sH tH   {Medium List 1 - Accent 13:V44 la 44B*PJ_H mH phsH tH   {Quotef:V044 la 44B*PJ_H mH phsH tH  # {Medium Shading 2 - Accent 1f:V044 la 44PJ_H mH sH tH ^2^ {0 Balloon Text d CJOJQJ^JaJmHsHtHV/AV {0Balloon Text CharCJOJPJQJ^J_H aJB' QB {0Comment ReferenceCJaJHbH {0 Comment TextCJaJmHsHtHB/qB {0Comment Text CharPJ_H @jab@ {0Comment Subject5\N/N {0Comment Subject Char5PJ\_H H HNpRevisionCJPJ_H aJmH sH tH PK![Content_Types].xmlN0EH-J@%ǎǢ|ș$زULTB l,3;rØJB+$G]7O٭VvnB`2ǃ,!"E3p#9GQd; H xuv 0F[,F᚜K sO'3w #vfSVbsؠyX p5veuw 1z@ l,i!b I jZ2|9L$Z15xl.(zm${d:\@'23œln$^-@^i?D&|#td!6lġB"&63yy@t!HjpU*yeXry3~{s:FXI O5Y[Y!}S˪.7bd|n]671. tn/w/+[t6}PsںsL. J;̊iN $AI)t2 Lmx:(}\-i*xQCJuWl'QyI@ھ m2DBAR4 w¢naQ`ԲɁ W=0#xBdT/.3-F>bYL%׭˓KK 6HhfPQ=h)GBms]_Ԡ'CZѨys v@c])h7Jهic?FS.NP$ e&\Ӏ+I "'%QÕ@c![paAV.9Hd<ӮHVX*%A{Yr Aբ pxSL9":3U5U NC(p%u@;[d`4)]t#9M4W=P5*f̰lk<_X-C wT%Ժ}B% Y,] A̠&oʰŨ; \lc`|,bUvPK! ѐ'theme/theme/_rels/themeManager.xml.relsM 0wooӺ&݈Э5 6?$Q ,.aic21h:qm@RN;d`o7gK(M&$R(.1r'JЊT8V"AȻHu}|$b{P8g/]QAsم(#L[PK-![Content_Types].xmlPK-!֧6 0_rels/.relsPK-!kytheme/theme/themeManager.xmlPK-!R%theme/theme/theme1.xmlPK-! ѐ' theme/theme/_rels/themeManager.xml.relsPK] 3D -125 W0454:4445 !!-3P\n *  $ !-3P\bFFFFFFFFFFFFF8@0(  B S  ?Text1Text2_GoBackvCHLPTuu!4Po % 8FfMyn|4*0YHa~RX"a=g8v` x{MENfnmr7r^K}@ccccp @,@`@2h@UnknownG*Cx Times New Roman5Symbol3. *Cx Arial9Garamond;Wingdings7.@Calibri9. . Segoe UIA$BCambria Math hUKg'XKg'\~ 9\~ 9!r4K#QHP ?{2!xx .Department of Psychology, University of ToledoSahu, Aparna AmiyaKim L. Gratz, Ph.D.Oh+'0  (4 T ` lx0Department of Psychology, University of ToledoSahu, Aparna AmiyaNormalKim L. Gratz, Ph.D.3Microsoft Office Word@ @4@㟩\~՜.+,0, hp  Universdity of Toledo9  /Department of Psychology, University of Toledo Title  !"$%&'()*,-./0123456789:;<=?@ABCDEGHIJKLMPRoot Entry FbRData #1Table+f$WordDocument>DSummaryInformation(>DocumentSummaryInformation8FCompObjr  F Microsoft Word 97-2003 Document MSWordDocWord.Document.89q