CSUPERB TRAVEL PROGRAMS EVALUATION FORM

Please complete the following evaluation form to help CSUPERB better serve the travel needs of the CSU Faculty and Student

[Note: A * denotes a required field.]

Please Provide the Following Contact Information:

*First Name:**
*Last Name:**
*Campus:**
*Department:**
*Email:**

Please Provide the Following Travel Information:

Travel Category (Please select one):

	Faculty who presented work at a meeting
	Faculty who accompanied a student who presented work at a meeting
	Faculty who attended a workshop or meeting
	Student who presented work at a meeting
	Other: Please explain

Travel Information:

Meeting Date(s):
Name of Meeting:
Travel Funds:	Please list sources and amounts from each source for the portion of your travel that was NOT funded by CSUPERB. This information is critical for the growth of the CSUPERB Travel Programs.

Briefly describe the extent to which your research presentation or your workshop participation helped you with each of the following:

RESEARCH ENHANCEMENT

CAREER ENHANCEMENT

DEVELOPMENT

EDUCATIONAL/PROFESSIONAL GROWTH OF YOUR STUDENT(S) (for faculty recipients who traveled with students):

Submit Information:

Thank you for taking the time to complete the Travel Evaluation Form!

After you have submitted your form you should be directed to a web page acknowledging receipt of your application. If you do not get that message page, please immediately contact:

Eric Nedelman
CSUPERB
619-594-2822

Click to submit your request.

Click to clear your application form and start over.