First Name:

Last Name:

Your University or
Academic Affiliation:

Do you have a poster paper accepted at GECCO?


Submission ID numbers:

Yes   No

Do you have a full-length paper accepted at GECCO?


Submission ID numbers:

Yes    No

Do you have a paper accepted at a GECCO Workshop?


Workshop name:

Yes   No

Are you an undergraduate student?

Yes    No

(optional) Are you a member of an underrepresented minority (Woman, Hispanic, Pacific Islander, African American/Black, Native American)?

Yes    No

Are you a citizen of the United States?

Yes    No

Budget Please note that air travel should be based on super saver airfares. Please provide budget in US dollars.

Travel (e.g., air/auto):

Housing:

Total:

Email Address:

Address:

Address 2:

Address 3:

City:

Postal Code / Zip Code

Country

Daytime Phone (including country code)

Your application is NOT complete until you submit your proof of student status. Submit your proof of student status by email, fax, or mail to:

Email :

I agree to submit an expense report, with original receipts, to

ACM / GECCO Student Travel Grants
Attention: April Mosqus
2 Penn Plaza, Suite 701
New York, New York 10121
USA