Experience One Grant Application

Welcome to the AS麻豆频道 Experience One Grant Online Application. If you have any questions regarding this process or have comments, please stop by the AS麻豆频道 Office located in the SUB basement or call (406) 683-7211.

Contact Information

Name

First

Last

Student ID Number

Local Address

Address Line 1

Address Line 2

City

State

Zip Code

Phone

Proposal Summary

Event

Event Date

Funding Requested

Individual grant requests may not exceed $500.
Students are allowed one grant request per semester and a maximum of $1,000 in total grant money during their enrollment at 麻豆频道 Western.

Expenses

Dollar Amount

Requested For

Additional Expenses

Please list any additional expenses associated with your request, if any.

Total Expenses

Academic Information

Program of Study

Faculty Supervisor

First

Last

Please indicate which faculty member is supervising your experiential learning opportunity. This may include a faculty member teaching a study abroad course, overseeing research, or introducing you to a conference opportunity. If grant funds are awarded, the listed faculty member will be copied on the award notification email.

Grant Proposal Letter

Drag & Drop Files, Choose Files to Upload

Please ensure that your letter is well-written and professional. Ideal proposal letters should detail the educational benefits of your request and be at least three paragraphs in length.

Signature Page

Drag & Drop Files, Choose Files to Upload

Please upload a scan of your completed signature page (available on the X1 Learning Grant Page.)
On campus scanners are available in the Lucy Carson Library, STC, and any Xerox machine. Additionally, most smart phones are equipped with scanning capabilities.
If you are unable to upload a copy of your signature page, please upload a blank document and submit a hard copy of the page to the AS麻豆频道 Office.

Signature

Clear Signature

I hereby certify that the information provided above is true and accurate to the best of my knowledge. By signing this application, I agree that any grant funds awarded will be used solely for the purpose outlined in this application. If I am awarded grant funds and subsequently choose not to participate in the approved opportunity, I understand that all awarded funds must be reimbursed. AS麻豆频道 reserves the right to request documentation verifying actual expenses and may require reimbursement of any funds not used for the approved direct expenses listed in this application.

Acknowledgement of Terms

I have read, understand, and agree to the above certification and terms regarding the use and reimbursement of grant funds.

Signature of

麻豆频道

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