SELF Grant Application

Application Name (first and last name)*
Applicant's Student ID number*
Applicant's Email Address*
Applicant's Student Classification*
Please indicate your student classification above.
Applicant's Primary Major*
Please indicate your primary academic major above.
Applicant's Secondary Major (if applicable)
Please indicate your secondary academic major (if applicable).
Type of Activity*
What is the type of experiential learning activity for which you are applying for a SELF grant?
Experiential Learning Activity Description*
In the space above, please describe the experiential learning activity in which you will be participating, including the date(s), location(s), purpose(s), and goal(s) of the activity.
Experiential Learning Activity Budget*
In the space above, please itemize the estimated costs of the experiential learning activity in which you will be participating. Examples of potential costs include travel expenses, conference registration fees, and program fees. In addition, please indicate any other sources of funding, aside from the SELF Grant, for which you have applied or are planning to apply in order to defray the costs of the activity.