Application for RSAT Host Site Visit 2015

 

Applicant Information  
:
:
:
:
:
(-
:
:
:
   
:
   
Check one:





:
   
Which host site are you applying to visit:
   
   
   
   
   
Authorization

Please enter the information on the supervisor of your program/unit below authorizing your to visit this host site, verifying that (s)he understands that BJA will not provide more than $1,000 to reimburse you for travel and other costs associated with the two day visit, and indicating that the institution is committed to using what you learn as appropriate to improve current RSAT programming in your institution.

Please note that no reimbursement will be made until an evaluation of the visit is submitted. The evaluation form will be provided by this office.
   
:
:
:
:
(-
:
Date Filed:
Now
   
Stipends

If applicant is seeking stipend for up to $1,000 to reimburse travel/lodging and meal costs, please provide estimated costs (please use federal GSA rates to estimate these costs, http://www.gsa.gov/portal/content/104877)
 

: