FINANCIAL SUPPORT PROGRAM STUDENT MOBILITY 2022 - 2023 April 2022 to March 2023
Please complete this form directly with Adobe Acrobat Reader and sign it (electronic signature accepted).
IDENTIFICATION
Last Name First Name
Student number Institutional email
Program of study Date 1st registration (yyyy-mm-dd)
Director- CRMR Co-Director-CRMR
DESCRIPTION OF THE ACTIVITY Title and address of the event Presentation title
Start date of the activity (yyyy-mm-dd) End date (yyyy-mm-dd)
Place
BUDGET ($ CAN) Registration
Transport ( specify the type)
Overnight accommodation ($/night*nb. nights)
Food ($/day*nb. days, use the per diem applicable at your university) Other information (please specify)
Total ($ CAD )
Other anticipated funding:
REQUIRED DOCUMENTS
• Application form
• The communication's abstract
• The proven acceptance of the communication
SIGNATURE STUDENT Date
SIGNATURE DIRECTOR/CO-DIRECTOR Date
TRANSMISSION
Send all required documents, including this form, in a single pdf file, by email to: [email protected]. Deadline:
30 days prior to the start of the activity.
