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                G A S   A N D   G A L A X Y   E V O L U T I O N

            A Conference in Honor of the 20th Anniversary of the VLA

                   Socorro, New Mexico, USA,  21-24 May 2000

          S T U D E N T   T R A V E L   G R A N T   A P P L I C A T I O N

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DEADLINE: 1 March 2000
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Please fill out this form and either
   (1) FAX to Ms. Terry Romero, at +1-505-835-7027 (voice: +1-505-835-7000)
or (2) send by paper mail to
          Gas and Galaxy Evolution Conference
          c/o Ms. Terry Romero
          NRAO
          P.O. Box O
          1003 Lopezville Road
          Socorro, NM  87801
          USA
E-mail or Web-based submission is impractical since a signature is required.


USE OF THIS FORM
  This form should be used to apply for student travel support.
  We are not sure yet whether or how much money will be available;
  at best such funds will cover only (partial) air fares, with a cap
  based on the cheapest air fare available.

IDENTIFICATION
  Last name:    ______________________________________________
  First name:   ______________________________________________
  Affiliation:  ______________________________________________
  Telephone:    ______________________________________________
  FAX:          ______________________________________________
  E-mail address: ____________________________________________
  Paper mail address:
             _____________________________________________________
             _____________________________________________________
             _____________________________________________________
             _____________________________________________________


  Citizenship:  _________________

  Professional level: 
    ___ Undergraduate         ___ Graduate student   
    Travel funds, if any, are available only to students.


TRAVEL PLANS
  Arrival and departure dates:

  Flying from where to where:


OTHER SOURCES OF FUNDING
  Please list other sources of funding available to you.


ABSTRACT
  Please submit an abstract form for the paper you wish to present at
  the meeting (required).  This form is available from the meeting Web site
  or via anonymous FTP, and is also reproduced at the end of the second
  mailing.

NAME OF SUPERVISOR & THESIS TOPIC
  Name of supervisor:  ______________________
  Thesis topic:



BACKGROUND INFORMATION
  Please attach a BRIEF Vita and Bibliography.

PASSPORT
  Expiration date of passport:
  (if a visa is required for your travel, your passport must be valid
  6 months beyond the visa expiration date)

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