RIVIERE-FABES SYMPOSIUM

                            April 5 - 7, 2002

                          School of Mathematics
                         University of Minnesota
                       206 Church St SE # VinH 127
                          Minneapolis MN 55455

        Request for graduate student or postdoc partial trip support


Use this form to give us the information we need.  You may fax the form
to 612-626-2017 (to the attention of Prof. F. Reitich), send email to
reitich@math.umn.edu, or use regular mail. Please have someone who knows
you well write a note that confirms your status, the possible value to you
of your participation, and identifies your research area. The writer of
your note may fax or email or mail it to the Chair of the Committee,
Prof. M. Safonov (safonov@math.umn.edu). If you successfully applied
for support last year and want to apply again this year, we will _not_ 
require a new recommendation from you, but please _do_ submit a newly 
completed form.


Your Name:_______________________________________

Institution:__________________________________________

Department Address: __________________________________

                    __________________________________

                    __________________________________

                    __________________________________

Email: _________________________

Phone: _________________________

Status:  grad _______ status ________(Orals+thesis left, etc.)

         Post Doc ________ yr _____(of PhD)

Arrival date: ____________________  Departure date: _____________________

Citizenship (for visa purposes) _______________________

The person who will write for you: _______________________________________



Partial Support information: The amount of support is tentatively set
to at most $750 per person. We can pay documented expenses only. We 
can pay up to $80 per night for lodging for any subset of Thursday 
through Saturday nights. Airfare, hotel, taxi and car rental receipts 
are required for reimbursement.

We must caution you that only domestic flights on US carriers can be
reimbursed. Let us know if this worries you! We _cannot_ pay you if you
have the "wrong" sort of visa (e.g. a tourist visa)! Let us know if you
have questions.