To request student FFR professional development funds, the student must provide the following information on this form and deliver it to the Office of the Provost, Academic Hall, Room 270. Please print or type.
 

Name:	SSN:				Date:
Major:	Local Address:				Phone:
GPA in Major:				GPA Overall:
Faculty/Professional Sponsor:
Description (Please mark the correct response):
Presentation/workshop at: ___ state ___ regional ___ national meeting/conference  Organization ________________________________________________________________________
Location:                                                       Dates:
Purpose (explain fully) Attach an abstract if available
Please explain how this activity will benefit you as a student.
Endorsement
We certify that this work is the result of the student's efforts alone or a collaboration with faculty, professionals, or other students at Southeast. We have reviewed the travel budget with this student.    ____________________________________________  Department Chair's/Head's Signature __________________________________________  Sponsor's Signature A written reflective report on the value of this experience is to be submitted to the department at the same time as the monthly expense account form.
ESTIMATED EXPENSES		Committee	Date Received:			Amt. Approved:
Transportation		Action	Date Approved:			Initialed:
Meals
Room		Approved by ________________________________ _______________
Other		Provost Date
Total Estimated Expenses $