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Brandeis University Student Information Sheet Name __________________________________________ Student ID#________________ Campus Box # ___________ Citizenship_ _________________ Class Year ____________ E-Mail Address ____________________________________ Phone ___________________ Home (or permanent) Address ___________________________________________________ ________________________________________________________________________ _________________________________________________________________________ Major(s) ___________________________________ Minor(s)___________________ Duration of Project: (check one) Summer 2005 _______ Academic Year 05-06 _______ Title of Project ________________________________________________________________ Brandeis Faculty Research Advisor ______________________ __________________ Dept. _________________________________________ ___Phone _______________ Off-Campus Advisor (if applicable) _________________________________ _______ University/Department_______________________________Phone _______________ 1. Have you previously received a Brandeis grant for this or any other project? 2. Have you applied for any other funds for this or other projects? If yes, which ones, and when will you be notified of award amounts? Please notify us
right away of receipt of any other funds. We cannot cover expenses already supported
by another grant. Previous URP winners are unlikely to receive repeat funding.
You are unlikely to receive both a Schiff Fellowship and a URP grant to support
related research.
Other Possible FUNDS: 3. Are you receiving academic credit for your research? List Course ID#__________ 4. What courses and experiences have prepared you for this research project (include courses in research methods, foreign languages, etc., if applicable)? 5. Total Budget Request (detailed on your enclosed Budget Request): $_________ Student's Signature ___________________________________ Date ________________ N.B.: All research projects that involve human subjects must adhere to the University's guidelines for the protection of human subjects in research. If applicable, check with your faculty supervisor to be sure that your research project meets these guidelines. BUDGET REQUEST
Please be realistic in itemizing your projected expenses; cite specific costs where possible and justify items in a narrative form where appropriate. Be specific. Please consult budget guidelines before preparing your budget request. URP has limited funds and, therefore, may not fund your full request. Please list your budget items on a separate piece of paper in order of importance to your project. Enter Your Total Budget Request (itemized on attached form): $ __________________ |