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Scholarly Activity Application Form

APPLICATION FORM
AUDIOVISUAL SUPPORT FOR SCHOLARLY ACTIVITIES
School of Graduate Studies and University Research
University of Wisconsin-Eau Claire

The purpose of Scholarly Activity funding is to encourage members of the University community to participate in professional activities and extend their knowledge base beyond the campus In order to offer consulting and resources to as many individuals as possible you are asked to plan your activity and expenditures carefully. Staff is available to assist you in this process.

PROCEDURE FOR FUNDING AUDIOVISUAL SUPPORT

Review needs and deadlines with Learning and Technology Services (LTS) staff.
Complete this form including attaching confirmation of presentation or publication.
Obtain department chair/administrator rating and approval.
Return signed form to LTS (Schofield 30). Production will begin AFTER receipt of this form.

REQUESTOR

Requestor:	_____________________________________________
Date:	_____________________________________________
Desired Date:	_____________________________________________
Department/Unit:	_____________________________________________
Organization/ Publication Title:	_____________________________________________
Description:	_____________________________________________
Services/ Materials Requested:	___________________________________________ ___________________________________________
I have read and agree to the policies and procedures as outlined. I have attached the confirmation of presentation or publication guidelines.
Requestor's Signature:	_____________________________________________
Date:	_____________________________________________

CHAIRPERSON OR UNIT ADMINISTRATOR

I have read this proposal and the policies for Audiovisual Support on the back of this application. I recommend the following (CHECK ONE).
	FUND DO NOT FUND
Department/Unit:	__________________________________________
Chair/ Administrator's Signature:	__________________________________________
Date:	__________________________________________

For LTS Use Only

Learning and Technology Services

Production Request No. __________________	LTS Authorization __________________	Cost Estimate __________________
LTS Director Approval:	________________________