ASC Dependent Care Grant Request Form

The Annenberg School for Communication is pleased to offer a Dependent Care Grant Program designed to support scholarship for ASC faculty, students, and postdocs who incur extra dependent care expenses (i.e., extra daycare, babysitting services, elder care, or care of a family member with disabilities) necessary to advance career progression and research. This includes travel to conferences, meetings, and training opportunities.
This form will be reviewed by the ASC Dean, the ASC Associate Dean for Research, and the ASC Executive Director of Finance, and a determination will be provided within two weeks of the application. If you are awarded the grant, we will follow up to ask that you complete a survey on how the grant met your needs at the end of the pilot period.

Please complete the fields below with information about yourself.
Please note that you will receive a copy of your responses to the email you list below.

Name

Email address

Best phone number

What is your affiliation with ASC?

Graduate Student
Postdoctoral Fellow
Faculty
Other

Please fill out the following fields with information about the dependent(s) for whom support is being sought.

Name of dependent(s)

Relation of dependent(s)

Age of dependent(s)

Please provide the following details about the activity for which you are seeking these funds.

Title of event

Date(s)

Location

In a few sentences, please explain how this activity meets the core areas or mission of ASC and your department.

Please list the types of dependent care expenses you anticipate using this grant for, and a cost estimate for each one. To list a new expense, click on the plus icon on the bottom left corner of the table below.
If you are unsure about the cost of a particular expense, please feel free to reach out to the ASC Business Office to assist with the estimate. Please note that the amount awarded will be dispersed as a single payment via payroll.

<b>Please list the types of dependent care expenses you anticipate using this grant for, and a cost estimate for each one. </b>To list a new expense, click on the plus icon on the bottom left corner of the table below.<br> <span style="font-size:16px;">If you are unsure about the cost of a particular expense, please feel free to reach out to the ASC Business Office to assist with the estimate. Please note that the amount awarded will be dispersed as a single payment via payroll.</span>



			Expense type	Estimated cost

We recognize that for some applicants, participating in professional development activities may be contingent upon receiving funding. If eligible for this grant, are you making a request to receive these funds upfront based on estimated expenses (i.e before the event) or after the event based on actual costs?
Please note that your response to this question will not affect your eligibility for this grant.

Before the event
After the event
No preference

If you have any additional details you think would be helpful as we review this request, please feel free to include them below.

If you are done with this form, please click the text below and the arrow button to continue. You will receive a copy of your responses to the email you provided at the beginning of this form.

I confirm that all of the information provided by me in this application (or any other accompanying or required documents) is correct, accurate and complete to the best of my knowledge. I understand that the falsification, misrepresentation or omission of any facts will be cause for denial of this grant. I understand that the award is taxable and will be reported as income on my W-2.