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Eberly College of Arts and Sciences  West Virginia University

WOMEN'S STUDIES DIFFERENCE FUND APPLICATION  (Print in landscape mode for best results.) The fund provides discretionary funds, primarily, to enhance the recruitment and retention of teaching assistants for WMST 170, the women's studies introductory course, which is taken by more than 240 students each semester.  This fund also enables undergraduate and graduate students to take advantage of student enrichment activities (field trips, internships, study abroad, workshop attendance, research, presentation of work) which would otherwise be impossible.  Maximum available amount per request each year is $250.  Applicant Name: _________________________________  Position: _________________________ Department/College: _______________________________________________________________ Local Address: ____________________________________________________________________ Permanent Address:  ________________________________________________________________ Work Phone: __________________  Local Phone: ___________________ Email Address:  _____________________________________________________________ Women's Studies Major/Minor: _____Yes _____ No Date activity begins: _______________________  Ends: ___________________________ Destination:  _________________________________________________________________________ Funds Requested: $_______________  Total Cost of Activity: $________________ Brief description of activity that funds are being requested for: ______________________________________________________________________________________________ ______________________________________________________________________________________________ ______________________________________________________________________________________________ ______________________________________________________________________________________________ Brief Description of how this activity will enhance your development in women's studies. ______________________________________________________________________________________________ ______________________________________________________________________________________________ ______________________________________________________________________________________________ ______________________________________________________________________________________________ ______________________________________________________________________________________________ ______________________________________________________________________________________________ Attach a one page proposal explaining your planned activity and a copy of your vita or resume, highlighting your women’s studies work. Itemized Budget Include details of total  estimated expenses, giving exact amounts for major elements of travel, lodging, etc. List actual amounts to be contributed from other sources. Description Total Dollar Estimate Funds from Other sources* Difference Fund Request Mode of Travel       Length of Stay/Lodging Estimate       Meal Allocation       Registration       Printing and Binding       Supplies       Other (identify)       Totals $ $ $             * identify source Explanation of budget needs and other sources of funds (both requested and received). ________________________________________________________________________________________________ ________________________________________________________________________________________________ ________________________________________________________________________________________________ ________________________________________________________________________________________________ I certify that the above statements are true. After the event for which I am requesting support, I agree to prepare and present a writing of 500 - 750 words about the funded event.  This writing may be edited and published in an issue of Nexus (the Center's newsletter), and/or used in any manner to promote the fund and the Center. Applicant's Signature: _____________________________________  Date: _________________________ Center Action:  Approved for $ _________________   Rejected: ______________________ Comments:   Director's signature/date:  ______________________________________________________________________                                                        1/03