Name:
Postal Address:
Email:
Homepage URL:
ACM member number:
(or date of application, if you have not received your number yet)
University Enrolled:
Department:
Degree pursued:
When you expect to finish:
Workshop to Attend:
Faculty advisor
Name:
E-mail:
Have you attended ACM CCS before?
Have you previously received an ACM CCS travel support?
ACM CCS program participation
Are you an author of an accepted paper(s), [list the titles and co-authors as ordered in the paper]?
If so, will you be presenting the paper(s) or poster(s) at the conference [list the titles]?
Have you published previously at CCS?
ACM CCS workshop program participation
Are you an author of an accepted workshop paper(s), [list the titles]?
Will you be presenting the paper(s) [list the titles]?
Have you published previously at CCS?
Type of Support Requested (choose ONE of the following):
A. CCS registration waiver
B. CCS and one-day Workshop registration waiver [name the workshop(s)]
C. Workshop registration waiver (Yes/No)
D. A check to cover registration and transportation cost? (Yes/No)
E. I will not be able to attend CCS without a full support of the trip
F. I will be able to attend without this support.