Sponsorship Request Form 2012 - 2013

Name (of individual or campus group): _________________________________ Phone Number: ___________________________________________________ E-mail: __________________________________________________________ Program (including major/minor): _____________________________________ Conference Title: __________________________________________________ Conference Date: __________________________________________________ Conference Location: _______________________________________________ Accumulated Cost: a. Airfare/Automobile/Transit (please identify): b. Registration: c. Accommodation: d. Food: e. Additional Costs (please identify): Total costs: $_____________ $_____________ $_____________ $_____________ $_____________ $_____________

Please use the space below to explain how this event will contribute to your professional development. Please use other side of sheet if necessary.

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I pledge that the above is accurate to the best of my knowledge. I understand that recipients are expected to submit a blog entry describing their experience for the Education Students Society (ESS) website, as well as live Twitter and Facebook updates while they are attending their event outlining things such as resources obtained, how this conference helped you become a better educator, people you met, and any other relevant information about the conference. I also understand that if these criteria are not met, the Education Students Society has the right to withhold the funding that is to be received after the event has taken place. Student Name (Printed):_________________________________________ Student Signature: ____________________________________________ Faculty Member Name (Printed):_______________________________________ Faculty Member Signature:____________________________________________ Date:_______________________________________
Please include a conference/event brochure and confirmation of registration (if not yet registered, please provide confirmation when received in order to receive funding) with ESS Funding Request Form. The more information you can provide about the event will be beneficial supplements to this application! The Sponsorship request form must be filled out and submitted prior to the date of the professional development event; the money for the claim will be paid out after the event has taken place. If you require the money beforehand please contact us and make arrangements. Please Note: The Education Students Society reserves the right to fund more or less than the amounts requested! Request forms can be mailed, dropped off in the Presidents Mailbox in the Education Lounge, or emailed in. The Information you will need is below! If you have any questions or concerns please do not hesitate to contact us! Education Students Society University of Regina ED 189Education Building 3737 Wascana PKWY Regina, SK, S4S 0A2 ureginaess@gmail.com