**Application for Travel Subsidy Grant to attend the 16^th^
International Couette-Taylor Flow Workshop, Princeton University,
Princeton, NJ, U.S.A, September 9-11, 2009**

# 

Complete all parts of this application, then submit the completed
application via email to Hantao Ji at <hji@pppl.gov>

Name:
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Email address:
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

I am (please check one):

-   Undergraduate student

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-   Graduate student

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-   Individual researcher and/or faculty

at the following institution:

> Institution:
> \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
>
> Department:
>
> Mailing address [(if you are chosen for a travel award, this is the
> address we will be putting on the check, so please make sure it is a
> current and a physical address):]{.underline}
>
> \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
>
> \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
>
> \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
>
> Telephone:
> \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
>
> Fax:
> \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

If you are a student, who is your research advisor at this institution:

> Advisor's name:
> \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
>
> Advisor's title (lecturer, assistant professor, associate professor,
> etc.):
>
> Advisor's email:
> \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Have you ever received a travel subsidy grant to attend an ICTW
workshop?

-   Yes Please indicate the year(s) in which you received the grant:
    \_\_\_\_\_\_\_\_\_\_\_\_\_

-   No

Are you giving a presentation at this year's ICTW workshop?

-   Yes

-   No

If you are giving a presentation at this year's ICTW workshop, enter the
title, authors, and complete abstract for this presentation below:

> Title:
>
> Authors (all):
>
> Abstract:

Estimate your total expenses to attend this year's ICTW workshop (in US
\$)

> Airfare: = \$ \_\_\_\_\_\_\_\_\_\_
>
> Ground transportation: = \$ \_\_\_\_\_\_\_\_\_\_
>
> Lodging: \_\_\_\_\_ nights x \$ \_\_\_\_\_\_/night = \$
> \_\_\_\_\_\_\_\_\_\_
>
> Meals: \_\_\_\_\_ days x \$ \_\_\_\_\_\_/day = \$ \_\_\_\_\_\_\_\_\_\_
>
> Meeting registration fee: = \$ \_\_\_\_\_\_\_\_\_\_
>
> **Total expenses:** = \$ \_\_\_\_\_\_\_\_\_\_

Other expenses I expect to have that are not included above are (please
enter type of cost and estimated amount):

Indicate proposed sources and amounts of all funds you plan to use for
the above expenses associated with your attendance at this year's ICTW
workshop:

Source #1:
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
Amount: \$\_\_\_\_\_\_\_\_\_

Source #2:
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
Amount: \$\_\_\_\_\_\_\_\_\_

Potential ICTW Travel Subsidy Grant (see instructions) Amount:
\$\_\_\_\_\_\_\_\_\_

I plan to share a room with at least one other attendee (please enter
yes or no)

[Other cost-saving measures I plan to take include:]{.underline}