CFP2000 Student Stipend Application Form

If you are interested in attending, please MAIL this application, together with a copy of your current student identification, and a brief cover letter stating how this event would benefit you in your current curriculum to:

Bleu Castaneda
USENIX Association
2560 Ninth Street, Suite 215
Berkeley, CA 94710
Faxed applications will not be considered.

Applications must arrive by January 31, 2000.

Click here for helpful hints and application guidelines.

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Name:

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Social Security Number (US residents only):

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Street address:

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Street address:

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City, State, Zip Code:

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Phone number:                                                    E-mail address:

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Academic Institution (If not included in mailing address)

Expense Request (In US Dollars. Please estimate as best you can.)

Travel:	$__________
Accommodation:	$__________
Registration fees
Student registration fee:	$__________
Total Requested:	$__________

(U.S. students, please note all awards $600 or over will be reported to the IRS. Recipients will receive a 1099 form.)

Are you a speaker at this conference?	____ No ____ Yes
Did you submit a session proposal or student paper?	____ No ____ Yes
If awarded a stipend, may we provide your name and email address to the USENIX liaison at your educational institution (if there is one)?	____ No ____ Yes
If awarded a stipend, may we provide your name and email address to other stipend recipients in order to help facilitate room sharing at the conference/workshop?	____ No ____ Yes

Date / Signature

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