Undergraduate Students Support for Experiential Learning

Please submit your request as early as possible (at least 4 weeks in advance of anticipated travel/event)

Firstname*

Lastname*

Student ID*

Carleton Email*

Phone Number

Department*

Degree*

Year Standing*

Nature of the request/Name of the event*

Travel/Activity details*

Justification*

Estimated total cost of proposed activity*

$ .00

I confirm that I meet the Eligibility criteria and the information I have disclosed is this form is complete and accurate.
I acknowledge that any inaccurate information is cause for the automatic declining of this request.
I understand that receiving resources pursuant to this request does NOT constitute sponsorship or endorsement of the event or activity by the Office of the Dean of Science or by Carleton University. The Faculty of Science and Carleton University assume no liability arising.

I fully understand, comply, acknowledge, and agree with the Terms of Agreement