Local Conference Grant Application

* Your full name:

* Your six digit professional number:

* Your school/work site:

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

* Are you a member of the NSTU Dartmouth Local? Yes/No

* What is your current assignment?

* Your mailing address (including postal code):

* Your email address (non-HRSB preferred):

* Your home phone number:

* Alternate phone number (work or cell):

* 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 Dartmouth Local PD funding? (Yes/No):

* This is to confirm all information provided in this application is true and accurate to the best of my ability. Your Name: