Mossburg Application

Judy Mossburg
Student, Faculty, and Staff Development
Grant Application
WVU Center for Women’s Studies
(Print in landscape mode for best results.)

This endowment income provides resources for the professional development of the staff and affiliated faculty, staff, and students enrolled in undergraduate and graduate women's studies programs. Funds can be used for workshop attendance, research, or presentation of work if such activities bring tangible benefits to the Center's program development. Maximum available amount per request each year for students is $500. Maximum available amount per request every two years for faculty and staff is $500. Please return this application to the Center for Women's Studies at:
218 Eiesland Hall
PO Box 6450
Morgantown WV 26506-6450

Applicant Name: ________________________________________ Position: _______________________________
Department/College: ____________________________________________________________________________
Local Address: ________________________________________________________________________________
Permanent Address: ________________________________________________________________
Work Phone: _________________ Local Phone: ________________________Email Address: _______________
Women's Studies Faculty Associate: _____Yes _____ No
Women's Studies Minor/Certificate Student: _____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.

______________________________________________________________________________________________

How do you plan to share the results of this activity with the WVU Women’s Studies community after you complete the work for which these funds are requested?

_______________________________________________________________________________________________

Attach a one page proposal explaining your planned activity and a copy of you 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*

Mossburg
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: ______________________________________________________________________

Revised 1/03