Application Form

FINANCIAL SUPPORT REQUEST

First name: XX

Last name: XX

E-mail address: XX

Age: XX

Affiliation (complete address of your department, laboratory, etc): XX

Citizenship: XX

Position of applicant (student, professor, assistant, etc): XX

(Expected) year of Ph.D: XX

Ph.D. granting institution: XX

Name and email of thesis advisor: XX, XX

Name and email of recommender: XX, XX

Expected travel expenses in USD (to be eligible for NSF funding, flights must be to and from the US and must be purchased from US-based airlines only): XX

Presenter at FPSAC 2014 (Y/N): XX

     If you answered YES : Talk or Poster?

Do you plan to attend the Permutation Patterns conference? XX

Brief justification of your application (maximum 10 lines): XX

Please email this form to fpsac14sup@gmail.com and have an advisor or mentor send a brief letter in support of your request to fpsac14sup@gmail.com with your name in the subject line.

Applications for support are due by March 15, 2014.