INSTRUCTIONS: Please complete the form below, and return the completed form (in plain text format) attached to an email with: subject line : Financial Support Request email address: siam2018_css@ou.edu The deadline is October 9, 2019. There will be limited funds available to partially defray travel and lodging expenses of conference participants, especially graduate student, postdocs, and early career mathematicians. The funds will be given out with preference given to more junior participants. In order to qualify for reimbursement, please make sure to carefully read and complete the form below. -- General information --------------------------------------------------- First Name: Last Name: Email: Affiliation: Position: Highest degree awarded: Year or expected year of Ph.D.: Primary field of interest: -- Demographic information ----------------------------------------------- Gender (male/female/decline to report): Race/Ethnicity (e.g. American Indian, Asian, Black or African American, Hispanic, Native Hawaiian, White, decline to report): -- Financial support details --------------------------------------------- Presenter (Yes/No): Travel (Yes/No): Lodging (Yes/No): -- List any other support you have applied for or will receive ----------- Amount + source of funding -- Provide a brief statement why you are applying for financial support --