Research Award Application Form

Copy the information below into a Word document that will become the cover page of your application packet.

Applicants may apply for more than one award in a given year, but must submit a separate complete application packet for each one.

Research Award Application

Award you are applying for (circle one):

Louis Agassiz Fuertes     Hall/Mayfield     Paul A. Stewart

Title of research project:  _________________________________________________________________

Name of applicant:  _____________________________________________________________________

Address for correspondence  ______________________________________________________________

City, State/Prov.  _______________________________________________________________________

Telephone:  _______________ E-mail address:  ________________________

Is this research the basis for a thesis or college degree? No ____ MA/MS ____ PhD ____ Other ___________

College/University affiliation (if any):  _______________________________________________________

High School affiliation (if any), if applying for the Hall/Mayfield Award:  __________________________________

Research Advisor:   ____________________________________________________________

Address:  ___________________________________________________________________

  __________________________________________________________________________

I have asked the following people familiar with my project and research abilities to submit letters of recommendation:

Reference #1  _____________________________________________________

Reference #2  _____________________________________________________

Deadline (received by): 1 February 2010