Midwest PDE Reimbursement Checklist

69th Midwest Partial Differential Equations Seminar
April 28-29, 2012
University of Illinois at Chicago
Reimbursement Checklist

Name: 		____________________________________

Address: 	___________________________________

		____________________________________

		____________________________________

SSN:		____________________________________

Tickets

[ ] If you are receiving reimbursements for airline, we will need the original receipt.

Foreign Participants

Foreign participants (not US citizens or permanent residents) receiving reimbursements, please attach copies of the following:

[ ] Visa (students – F-1 document)
[ ] I – 94 card (front and back)
[ ] Passport I D page
[ ] Passport VISA page
[ ] SSN card
[ ] J-1 visas holders only-letter from Home Department allowing us to reimburse participant
[ ] F-1 visas holders, send name of department business manager – reimbursements must be handled through Home Department

Please return at the Seminar or before November, 28, 2010 via mail to:

       Tasneem Chowdury
	   Attention: 69th Midwest PDE Reimbursement
       Department of Mathematics (M/C 249)
       University of Illinois at Chicago
       851 South Morgan
       Chicago, IL  60607-7045

The 69th Midwest Partial Differential Equations Seminar is partially funded by the National Science Foundation, the University of Illinois at Chicago Department of Mathematics, Statistics, and Computer Science, the UIC College of Liberal Arts and Sciences, the UIC Vice Chancellor for Research, and the Lewis Mathematics Seminar Fund.