CASA Travel Scholarship Application

Travel Scholarship Application

Application for FACC funded travel. Please submit at least 30 days prior to travel.

Name as it appears on driver's license/passport*
First Last
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code
Phone*
Email
I am a*
- CASA Volunteer
- FACC Board Member
- Other (please explain your relationship in "Other Important Information" below)
Program affiliation:*
I am requesting a scholarship for (check all that apply):*
- Registration Fees
- Mileage
- Airfare
- Lodging
- Meals/Per Diem
- Other
Amount you can pay:*
Approximate Amount of Scholarship Request*
Name of Event or Trip Purpose*
Location of Event*
Dates of Event (from and to)*
Name of Hotel
Is event being held at the above named hotel?
- Yes
- No
Are any discounts offered? If yes, please describe:
Date of birth (if requesting air travel)
MM slash DD slash YYYY
Alaska Airlines Mileage Number, if applicable
TSA Pre-check Number, if applicable
Seat preference
For lodging requests, I would like to bunk with:
Other Important Information?

Is there anything else we need to know before booking your travel? If you are not a CASA or FACC board member, please explain your relationship.
Acknowledgement of FACC Travel Policy*

With my initials above, I acknowledge that I have read the FACC travel policy and agree to follow it. I further agree to use the funds as per the FACC policy and acknowledge that I am responsible for providing full and complete receipts to FACC within ten (10) days of completion of the trip. I understand that if I fail to follow the policy, including submission of receipts, I may be liable for reimbursement to FACC for the full amount of any and all monies expended on my behalf.

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CASA Travel Scholarship Application

Travel Scholarship Application

Friends of Alaska's Children in Care

PO Box 242484, Anchorage, AK 99524-2484

info@friendsofalaskascc.org