Application for STaRS Coordinator Scholarship to support conference attendance1,2

Academic Professional

SECTION A PERSONAL DETAILS

Staff ID Number Contact Number

Name (incl title)

Email Address

Years of continuous employment at WSU

Full Time/Part Time:

CURRENT POSITION DETAILS

Position Title Level

Name of School or Unit Campus

Name of Supervisor

Name of Dean/Director/Executive Director

1. CONFERENCE

What is the title of the conference?

Have you submitted a paper for presentation at the conference? Yes No

OR Have you submitted a poster for presentation at the conference? Yes No

Has your Paper/Poster been accepted for presentation? Yes No

If yes, please attach a copy of the abstract and evidence that the paper has been accepted.

Please provide a web link address for the conference site:

When/where will the conference be held?

Date(s):

City: Country:

1 Eligibility: To be eligible to receive the scholarship funding requires acceptance of a paper or poster for presentation at the conference and is available only to STaRS Coordinators, with approval for conference attendance from their Dean or nominee. In competitive situations papers will be given higher priority than poster presentations.

2 Value of the Scholarship: Up to $1,500.Page 1 of 2

SECTION B COSTS

Please provide full details of costs, including conference registration fee, travel and accommodation costs (if applicable) and incidental costs.

Amount $Conference Registration Fee

Course / Activity Fee

Accommodation

Airfares

Meals / Incidentals

Other (Please specify)

Total:If the scholarship does not meet the full costs of the proposed activity, please state how will the balance be paid:

NOTE: If your application is successful, you are asked to share your experience with the STaRS Coordinators group.

Please submit your application by email attachment to:

David Roach – d.roach@westernsydney.edu.au

NOTE: This application will be acknowledged by email within 48 hours. If you do not receive acknowledgement, please phone David Roach Ext 3406

NT POSITION DETAILS

SUPPORT BY DEAN / DIRECTOR

I support this application for the STaRS Coordinators Scholarship

Name:

Position:

Signature:

Date:

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