ADULT STUDENT AFFAIRS

DePaul University
1 E. Jackson, Room 11017
Chicago, Illinois 60604

TRAVEL APPLICATION FORM

ADULT STUDENT ASSOCIATION

Date ______________________
Name ___________________________________________________________________________
Academic Program______________________________________________
Graduate or Undergraduate Student _____________________
GPA ___________
E-mail___________________________________
Daytime Telephone _______________________________________________
Mode of Travel (if car, list mileage here)_______________________________
Budget Transportation _____________________

Hotel _____________________

Registration _____________________

Other (specify) _____________________

Total _____________________

Signature of Applicant __________________________________

PLEASE SUBMIT WITH THIS APPLICATION

1. Essay describing how this conference/event will contribute to your educational experience
(100-250 words)
2. Official application to conference or event
3. Official Letter of Acceptance
4. Faculty Advisor letter of support
*********************************************************************************************************************
Certification by Faculty/Advisor
This conference/event has an educational component that will contribute to this student’s progress towards
his/her degree.

______________________________________________
Academic Advisor/Faculty/ Departmental Representative

Please return completed form to Bernadine Thomas, Assistant Director in the Adult Student Center (Rm.
11015),