a 501(c)3 nonprofit organization; donations are deductible for Federal tax purposes

DUE: January 15th for Conferences from April – December; July 15th for Conferences from October – March.
(See directions below.)

Soft Coated Wheaten Terrier (SCWT)
Student Researcher Professional Development Award Application

Sponsored by SCWTCA Endowment, Inc.
(Read important guidelines on page 2 of this application form.)

Name _____________________________________________   College/University_____________________

Local Address ___________________________________________________________________________

City____________________________________________________   State______   Zip code: ___________

Telephone_____________________________________   Email ____________________________________

Major(s) ______________________________________________   Sequence ________________________

Degree Program (check one):  ____Bachelors    School Standing:   ____Masters   ____Doctoral   ____Post Doc

Conference Name ________________________________________________________________________

Level (check one):  ____Area (w/in State)   ____State    ____Regional    ____National    ____International

Location __________________________________________      Date(s) _____________________________

Check the category that best describes your role at the conference:

 ____Presenting (Attach abstract accepted for presentation.) __(title of presentation)________________

 ____Assisting Faculty Member/Mentor Presenting a Project You Contributed To (Attach abstract.)

 ____Presiding or Other Official Duty. (Describe.) _________________________________________

 ____Volunteering or working. (Describe.) _______________________________________________

 ____Attending

Amount of Financial Request:____________ (Fill out proposed budget on page 2 of this application form.)

If not presenting or assisting a faculty member who is presenting results from a project involving SCWTs that you have work on, explain your involvement with a project involving SCWTs. Why did you select this conference to attend? How might this educational experience benefit you as a future professional? ________________________
_______________________________________________________________________________________

Principal investigator or faculty member aware of your work on the research project and who will provide a letter of recommendation detailing your involvement:
Name ______________________________________________________   Email ______________________

Return to: Carol Carlson kccarlson@comcast.net with verification of acceptance to present/participate in the conference named above. Email a copy of this completed application form to the faculty member named above. Copy Carol Carlson on a request for the same faculty member to submit a letter of recommendation. Online application form available at http://www.wheatenhealthendowment.org.

page 1

INCOMPLETE APPLICATIONS WILL NOT BE CONSIDERED!

2/23/11

a 501(c)3 nonprofit organization; donations are deductible for Federal tax purposes

DUE: January 15th for Conferences from April – December; July 15th for Conferences from October – March.
(See directions below.)

Soft Coated Wheaten Terrier (SCWT)
Student Researcher Professional Development Award Application

Sponsored by SCWTCA Endowment, Inc.
(Read important guidelines on page 2 of this application form.)

Sample budget:

 

Proposed budget:

Important guidelines:

1. Priority given to post doc, doctoral, masters, bachelors (senior – freshman)
2. Priority given to level of involvement: a.) presenting or co-presenting, b.) assisting presenter, c.) presiding, d.) volunteering or working at the conference, d.) simply attending.
3. Students who receive travel funds are expected to share this educational experience with their peers (e.g. presentation in class, student organization presentation, etc.).

page 2

INCOMPLETE APPLICATIONS WILL NOT BE CONSIDERED!

2/23/11