Graduate Colloquium Application Form

Department :
Department Head :
Sponsor Name :
Sponsor Phone :
Sponsor Email :
Proposal Term


Speaker Title : (Dr., Mr.,etc)
Speaker First Name :
Speaker Middle Initial :
Speaker Last Name :
Speaker Position :
Address Line 1 :
Line 2 :
Line 3 :
City :
State :  OR
Zip or Postal Code :
Country :


Speaker Designation:

Lecture Title :
Lecture Day :
Lecture Date : (mm/dd/yyyy)
Lecture Time :  (hh:mm AM/PM)
Lecture Place : 
   
Seminar Title :
Seminar Day :
Seminar Date :  (mm/dd/yyyy)
Seminar Time :   (hh:mm AM/PM)
Seminar Place :

Posters :                         

Justification of Lecture/Seminar Topic :


Justification of Speaker :


Role of Graduate Students in Speaker Selection :


Budget : If total payment to speaker is $400 or less, do not itemize. Over $400, MUST provide an estimated itemized budget.

Travel (as appropriate) :  

Airfare (average 2-week advanced purchase coach fare)

Transportation to/from departing airport

Transportation to/from arrival airport

Personal Automobile Use (est. mileage x $0.485/mile)

Rental Car (rental plus gas/tolls)

Lodging (standard Holmes room rate with taxes $75/day)
Meals (standard state-mandated rate of $7/meal up to 4/day)
Speaker Fee (additional remaining amount to be paid)


Notes: