UVic Term Sessional Lecturer Scholarship Fund
Application and Budget Form

Submit your application package by email to the Division of Learning and Teaching Support and Innovation (LTSI). To do this save this form as a Word file and then rename it with your surname and year in the file name: e.g. <LastName_TermSess_Scholar_Form_YEAR> to < ltsipc@uvic.ca >. 

1. Background Information

Applicant Name: ________________________________________

Email: _______________________________	Contact phone: ____________________________

I confirm that, as defined by the Collective Agreement for CUPE 4163, Component 3, I am currently a Term Sessional Lecturer at UVic in the department(s) of _____________________________________ (NOTE: If you are unsure of your status please check with your CUPE office at cupe4163@uvic.ca)

Signed: ______________________________________            Date: ________________________________

When did you last teach as a Term Sessional Lecturer?

Term & Year: ________________________		Course(s):______________________________________

Name/title/nature of activity for which you are applying for funding (please attach any relevant
documentation such as invitations or acceptance letters, conference brochure showing your participation if presenting, etc. URL of event website is not sufficient.):

Date(s) and location(s) of activity:

2. Application

Please answer the following questions:
i.	What will the nature of your participation be (e.g., panelist, presenter or attendee)?

ii.	How will the event/activity contribute to your professional development as a Term Sessional Lecturer in your discipline?

iii.	How will the event/activity translate directly into your teaching and contribute to your students’ learning?

3. Budget—Please list all estimated costs for which you are applying including any relevant taxes, converting all budget values into Canadian funds. Please also detail any matching funds you have received/will be receiving.

Item (including taxes if applicable)	Cost	
Professional organization membership fees associated with attendance

Registration fees

Travel

Accommodation (Please specify: ___ nights at a room rate of $_____ incl. taxes per night)

Meals (excluding alcohol)

Materials costs (e.g. creating a poster)

Other (please specify)_________________________
		
Total Anticipated Costs
		
Less funding obtained from other sources (e.g. Department/Dean or external organization)		
Sub Total		
Total amount requested from the Term Sessional Lecturer Fund (up to $1,000 for attending; $2,000 for presenting)	

Please note:

1.	Reimbursement can only be made for items for which original itemized receipts (including boarding passes for air travel) are subsequently provided. This is in compliance with the University’s travel expense policy.
2.	If payments for hotel and airfare, or any other expenses, are made by credit card, a copy of the credit card statement (with the credit card number blanked out) is required by Accounting for proof of payment.