UVP Department Nomination and Commitment Form - Graduate School Diversity Office - The Graduate School

Student Information

Student's Last Name

Student's First Name

Date of Visit

Student's Visitation Schedule

Sponsor Information

Sponsor's Last Name

Sponsor's First Name

Department

College/School

If other, please specify

Campus Phone Number

Email Address

Sponsorship Type

Faculty sponsorshipDepartment sponsorship

Please indicate the sponsorship amounts for appropriate fields:

	Airfare	Lodging	Total Amount
Expense Amounts

Please attach a copy of the airfare receipt

Additional Information

Please list the contact information for who is responsible for graduate diversity recruitment efforts in your college/department.

Recruitment Contact Name

Recruitment Contact Title

Email Address

Campus Phone Number

How does your college/department recruit diverse graduate students? (Check all that apply)

List Advertisement Information

List Academic Conference(s) Information

List Graduate School Fair(s) Information

If other, please specify

Acknowledgement

By checking box below, I confirm that I am sponsoring the student mentioned above in the University Visit Program. I am responsible for half of the total cost of airfare and lodging. I also understand that the Graduate School Diversity Office only offers support to students who have been accepted into a graduate program.

I have read and agree to the terms stated above.

First and Last Name

Date

Graduate School Diversity Office Only

Received Date

Awarded or Denied?

Awarded/Denied Date

Reason

University Visit Program

Department nomination and commitment form