National/International Grant

* Your full name:

* Your six digit professional number:

* Your school/work site:

* Your contract status (Permanent, probationary, term):

* Your mailing address (including postal code):

* Your home phone number:

* Alternate phone number (work or cell):

* Your non-employer email address (NSTU preferred):

* Name of conference:

* Location of conference:

* Start date of conference:

* End date of conference:

* Brief description of conference:

* Conference website:

* Conference registration fee:

* Estimated travel cost:

* Estimated cost for accomodations:

* Estimated cost for meals:

* Have you applied for Article 60 funding?
Yes
No

* Have you been approved for Article 60 funding?
Yes
No
Pending

* Have you applied for or been approved for other sources of funding?
Yes
No

* If yes above, what type(s) of funding:

* Have you read and do you understand the guidelines for Halifax City Local PD funding?
Yes
No