SIPA: School of International and Public Affairs at Columbia University

Student Information:

Last Name 

First Name 

Email/UNI Address @columbia.edu

Personal Identification Number PID Number

Graduation date: Month May October December Year 2004 2005 2006 2007 2008 2009

Local Phone Number

Country of Citizenship

International Students CANNOT receive a travel grant for travel to their COUNTRY OF CITIZENSHIP Are you a U.S. Green Card Holder?

Select One Yes No

Exception: U.S. Green Card holders can receive a travel grant to their Country of Citizenship. If this case applies to you, you must submit a copy of your green card with your travel grant application.

Internship Information

Organization Name

Address

City

Country

Location of Internship, City

Country

Supervisor

Title

Email

Phone

Fax

Dates of Internship

From: Day 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 Month May June July August September Year 2004 2005 2006 2007 2008

To: Day 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 Month May June July August September Year 2004 2005 2006 2007 2008

Hours per Week

Will you receive a salary? Select One Yes No

If yes, amount:

Have you applied for internship funding from any other source

If you have received funding from any other source, please specify amount

Will you receive housing? Select One Yes No

Travel Grant Eligibility

Please check the "Yes" box to confirm that you have read, signed, and accept the terms of the "Travel Grant Eligibility Agreement."

Yes  No

Please check the "Yes" box to confirm that you have read, signed, and accept the terms of the "Travel Grant School Disclaimer Agreement."

Yes  No

Please check the "Yes" box to confirm that you have read the Travel Safety Information, Current Travel Warnings, and Health and Insurance Information web pages

Yes  No

Please check the "Yes" box to confirm that you understand OCS will be verifying internship placements during the summer - and that you are aware that you will be held fully responsible for reimbursing SIPA for any violation of this agreement or if the grant is used for anything other than for funding your fare overseas.

Yes No

Disbursement Information:

Direct Deposit to Bank Accounts, Paper Checks:

If you have set up direct deposit with Columbia University, you can request a refund through SSOL and the funds will be deposited into your account. Please note that if you have any outstanding balance with Columbia University, the travel grant will be applied to your balance.

If you have direct deposit already set up and want a paper check, you must go to Student Financial Services to cancel your direct deposit and request a refund. Please note that this will cancel the process for all Columbia payments to your account. You will have to complete another direct deposit form to reactivate the process for the fall semester. Checks will not be available for pick up. They will be mailed from the Payroll office to your home (the address Columbia has as your residence). Please note that this may pose a problem if you are not at that residence for the summer so this method is not recommended.

Dual Degree Students:

If you are a dual degree student, you may not see the award yet as the funds were dispersed to your dual degree university and it must post the funds to your account.

Please note: Your application will not be complete until you submit the following support documents to OCS:

1. a confirmation letter from your employer mailed, faxed (fax #:212- 854-6190), or emailed (sipa_ocs@columbia.edu) to OCS. Confirmation letters must be on organizational letterhead and verify the project description, salary, start and end dates of the internship, and work hours per week;
2. a signed copy of the Travel Grant Eligibility Agreement;
3. a signed copy of the Travel Grant School Disclaimer Agreement; and
4. for International Students, a signed copy of the Attestation Form for Receiving Grants and Stipends.