American Philosophical Society



6/2020 Astrobiology For Office Use

Date Received

Subject

Referees

Prior Appls

American Philosophical Society

104 South Fifth Street

Philadelphia, PA 19106-3387

Lewis and Clark Fund for Exploration and Field Research

in astrobiology

Respond to every section; if the answer is "none" or "not applicable," type this in the space provided. Delete extra line spaces whenever necessary to maintain 4-page format.

Send your application as an e-mail attachment to: applications@.

NAME in full, last name capitalized :

Best MAILING ADDRESS :

TELEPHONE, E-MAIL :

INSTITUTIONal Affiliation :

PRESENT POSITION and Field of Study :

CITIZENSHIP :

Undergraduate and graduate EDUCATION

institution degree & date field of study

institution degree & date field of study

institution degree & date field of study

Project Title:

Brief Description of Field Trip or Exploratory PROJECT

DATES of trip or project:

Amount of Funding requested:

NAME___________________________

STATEMENT of purpose

Indicate in the space below the nature of the studies to be undertaken, the hypotheses to be tested, and the observations to be made. Also describe the site and the equipment and methods to be used in the field and laboratory. Describe safety and training procedures when the field trip involves travel to potentially hazardous locations. Reference the connection to astrobiology via the Astrobiology Roadmap. (5,500 character limit, including spaces, i.e., one page.)

NAME___________________________

Relevant publications or graduate student research projects

RELEVANT LANGUAGE SKILLS and TRAVEL EXPERIENCE

Any Additional relevant information?

BUDGET STATEMENT

BUDGET $ amount month/year dates

travel

subsistence

personal equipment/supplies

Total

Explain the reasons for the requested budget allocations.

NAME___________________________

OTHER GRANTS applied for to support this trip or project.

Name of fund purpose (e.g., salary, supplies, etc.) dates amount requested

List all grants received, or awarded, within the past five years, indicating the amounts received and the dates of tenure.

granting agency amount dates of tenure

NAMES and e-mail addresses of two experts you have asked to support this application. A graduate student applicant should ask his or her academic supervisor or field trip leader to write one of the two letters of recommendation, specifying the role of the student in the field trip and the educational contribution of the trip. Download the referee letter from the APS web site, forward it to your letter writers, and notify them of the deadline; confirm with them that the letters have been sent in time.

name brief address / name of institution telephone/email

1.

2.

DATE of application ________________________________________________

Send as an e-mail attachment to applications@. To verify that all materials have arrived by the deadline, call 215-440-3429 or write to LMusumeci@.

6/2019

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