(Note: An * indicates a required field.)

WPSA Travel Grant Application Form

For what travel grant are you applying? (check one)
Elsa Favila Travel Award
Pi Sigma Alpha Undergraduate Travel Award

*First Name:

*Last Name:

Institution:


*Address:

* City

Please enter "none" if no state/province.
*State/Province:

*ZIP/Postal Code:

Country:

TELEPHONES (U.S. residents, please include area code.  International residents, please include country and city codes.):
Home:

Work:

*E-MAIL:

*Rank:

Form of Participation in Upcoming Conference (Mark all that apply)
Paper Presenter
Discussant
Panel Chair
Section Chair
Undergraduate Poster Session
Other
    Explain :

If presenting paper or poster, please provide the title of your work

Panel number

Estimated miles from home to conference hotel

Will you be receiving travel funds from any other source?
    Explain :

Any additional information to consider

If you are experiencing any problems or have questions, please send a message to info@wpsanet.org.