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Request Form for Student Opportunity/Travel

The Center for Ethics and Public Engagement reserves a portion of its endowment funding to support student scholarship. The amount of funding available in each academic year is dependent on a variety of factors, including the state of the endowment and the other demands upon it in a given year.

** Before you request funds from the CEPE, we ask that you first request funds through the Dean's Office.

Funding decisions are made by the CEPE board, which meets monthly. Please make your request with enough notice for the board to discuss your proposal at their next monthly meeting. Requests must be received at least SIX weeks prior to the date of travel. As you complete this form, if you have questions, please contact the CEPE by emailing [email protected]

* = required field

Student Name:*

Luther Student ID:*

Graduation Year:

Email:*

Faculty/Project Advisor Name:

List related class, department, and instructor if applicable:

Name of Conference or Event:*

Dates of Conference or Event:*

Please explain how the requested funds would be used (Be as specific as possible):*

Are you attending the event as a participant or presenter?

	Participant
	Presenter

The CEPE seeks to fund student experiences that help promote the Center's goals, mission, and annual theme. Please explain how this experience fulfills these criteria. If possible, explain how this experience relates to/grows out of your own past participation in CEPE events and programming:

How will you use your experience to enrich others upon returning? Will you participate on a panel? Participate in an interview? Share in a class setting, peer group, or student leadership group? Please list ideas you have for sharing what you've learned:

Please explain how the requested funds would be used (be as specific as possible):

Travel Costs:

Lodging Costs:

Food Costs:

Other (Please Explain):

Total Expenses:*

What other sources of funding are you pursuing? (Indicate whether the funding applications have been submitted and/or approved:

Amount Requested from CEPE:*

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