Student Stipend Application Form

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

Cami Edwards
USENIX Association
2560 Ninth Street, Suite 215
Berkeley, CA 94710

NOTE: We cannot consider your application without a copy of your current student identification card and a completed registration form. Faxed applications will not be considered.

Applications must arrive by January 22, 1999.

If you have not yet received information about registration, please contact the USENIX conference office at tel: 949/588-8649 or send mail to conference@usenix.org.

Click here for helpful hints and application guidelines.

______________________________________________________
Name:

______________________________________________________
Social Security Number (US residents only):

______________________________________________________
Street address:

______________________________________________________
Street address:

______________________________________________________
City, State, Zip Code:

______________________________________________________
Phone number:                                                    E-mail address:

______________________________________________________
Academic Institution (If not included in mailing address)

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

Travel:	$__________
Accommodation:	$__________
Registration fees
Technical sessions:	$__________
Tutorial sessions:	$__________
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 presenting a paper at this conference?	____ No ____ Yes
Have you ever received a USENIX Student Stipend?	____ No ____ Yes ___________ Date
Have you ever applied for a USENIX Student Stipend?	____ No ____ Yes ___________ Date
Have you ever received a USENIX Research or Undergraduate Software Grant?	____ No ____ Yes ___________ Date
Are you a member of USENIX Association?	____ No ____ Yes
How did you hear about USENIX Student Stipend?	;login: ____ Web _____ Newsgroup ______ Campus Rep______ Other ____________________________________
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

_____________________________________

As a student, you may receive regular member benefits for only $25. If you are interested, please contact office@usenix.org.