IEEECSS

CSS Travel Support Request Form

Please fill out all applicable boxes. Erroneous or incomplete information may lead to denial of requested support.

Your Name:
IEEE Member No.:
Your Email:
Department:
Organization:
Street Address:
City, State, Zip:
Country:
Conference:
Prior Support:
Min. Income Status:

Paper No. 1: Title
Complete title of your paper number 1
Paper Type:
Session No.:
Name(s) of Co-author(s) as they appear on paper
Co-author 1:
Co-author 2:
Co-author 3:

Paper No. 2: Title (skip this section if you only have one paper)
Complete title of your paper number 2 (if applicable)
Paper Type:
Session No.:
Name(s) of Co-author(s) as they appear on paper
Co-author 1:
Co-author 2:
Co-author 3:

Paper No. 3: Title (skip this section if you only have one or two papers)
Complete title of your paper number 3 (if applicable)
Paper Type:
Session No.:
Name(s) of Co-author(s) as they appear on paper
Co-author 1:
Co-author 2:
Co-author 3:

Statement of Justification:

I have read and agree with the criteria for receiving the travel support and the extent of the support to attend the conference. I understand that if selected to receive the grant, I will attend the conference to present the paper and that I will be responsible for all expenses incurred by me that are not covered by the grant.