DOT

Name(Required)

First Last

Agency(Required)

Type of agency(Required)

Executive Director or Administrator(Required)

Address

Street Address Address Line 2 City State ZIP Code

Email(Required)

Phone(Required)

Fax

Attendee's position(Required)

Location(Required)

Name of conference or program(Required)

Sponsor

Program dates(Required)

Please provide justification for program attendance and scholarship request

Registration fee or tuition

Air fare

Train fare

Ferry fare

Taxi fare

Bus fare

Rental car

Tolls

Milage (0.70 per mile)

Parking

Lodging

The maximum allowable lodging reimbursement shall equal U.S General Service Administration per diem rates (link opens in new window) for the current fiscal year based on the location and date of the course, conference, or workshops.

Meals (number days at no more than $40 per day)

The maximum allowable for meal reimbursement shall equal U.S General Service Administration per diem rates (link opens in new window) for the current fiscal year based on the location of the course, conference, or workshops.

Total estimated expenses

Agency contribution

Amount of scholarship request