Visiting Women Scholars Award Program Evaluation Form

Please completely fill in the following information. After you have reviewed and checked your input, click on "Mail Form" to send this form or use "Reset Form" to cancel this form.

Funds will be journal vouched to your department only upon receipt of a completed evaluation form and the required account statement information.  Accounts Payable requires that JVs include information on when the charges hit the account statement.  Please type out the line exactly as shown on your statement or fax us a copy (extension 2063) of the account statement page where the charges appear. 

EVALUATION
 
Person Evaluating Program:
Email Address:
Department:
Telephone:

 VISITING WOMAN SCHOLAR
 
Name:
Address:
Discipline:
Topic/Title of Talk:
Program Description:
Date of Visit:
Time:
Location:
Description of Publicity:

 JOURNAL VOUCHER INFORMATION
 
Account Code:
Account Title:
Email Address for Copy of JV:
Statement Line:

 FUNDING BREAKDOWN
 
VWS Amount Requested: $
* Department Funding: $
* Must match or exceed VWS funding
* Other Funding Sources: $
* Must match or exceed VWS funding
Total Funding: $

 NUMBERS INVOLVED WITH VMS
 
Faculty/Staff Women:
Faculty/Staff Men:
Undergraduate Woman:
Undergraduate Men:
Graduate Student Women:
Graduate Student Men:
 
Did the use of funds from the Visiting Women Scholars Award Program make this visit possible?
 
Please comment on the value of the program to your department: