CANMES TRAVEL GRANT
APPLICATION FORM

Name: ___________________________________________

Mailing Address:

___________________________________________

___________________________________________

___________________________________________

Tel/Fax: ___________________________________________

E-mail: ___________________________________________

University/Department enrolled in:

___________________________________________

Program and year: ___________________________________________

Conference name and location:

___________________________________________

Title of Paper (if available):

___________________________________________

Amount of available institutional or grant support: ___________

Amount requested: ___________

For Official Use Only:

Decision: ___________

Grant Amount: ___________

Send application to:

Amal Ghazal
Department of History
Dalhousie University
Halifax, NS
B3H 4P9
Canada