ACM CCS Student Travel Support Application

Name:

Postal Address:
Email:
Homepage URL:

ACM member number:
(or date of application, if you have not received your number yet)

University Enrolled:
Department:
Degree pursued:
When you expect to finish:
Workshop to Attend:

Faculty advisor
Name:
E-mail:

Have you attended ACM CCS before?
Have you previously received an ACM CCS travel support?

ACM CCS program participation
Are you an author of an accepted paper(s), [list the titles and co-authors as ordered in the paper]?
If so, will you be presenting the paper(s) at the conference [list the titles]?
Have you published previously at CCS?

Type of Support Requested (Choose ONE of the following):
A. CCS registration waiver
B. CCS and one-day Workshop registration waiver [name the workshop(s)]
C. I will not be able to attend CCS without a full support of the trip (max of $905)
D. I will be able to attend without this support.