American Philosophical Society



6/2017 For Office Use - Astrobiology

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

Respond to every section; if the answer is "none" or "not applicable," type this in the space provided. Send your application as an e-mail attachment to: applications@.

NAME:

Last:       First:      

Best MAILING ADDRESS:

Address 1:      

Address 2:      

City:       State:    Zip:     

TELEPHONE:      

E-MAIL:      

INSTITUTIONal Affiliation:

     

PRESENT POSITION:

     

Field of Study:

     

CITIZENSHIP:

     

Undergraduate and GRADUATE EDUCATION

Institution degree & date field of study

                 

                 

                 

                 

Project Title:      

Brief Description of Field Trip or Exploratory PROJECT, including location (300 characters max.):

     

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, which may be found at . (5,500 character limit, including spaces, i.e., one page.)

     

Relevant publications or graduate student research projects:

     

     

     

     

     

relevant language ability and TRAVEL EXPERIENCE:

     

Any Additional relevant information?

     

BUDGET STATEMENT

Travel:

$ amount      month/year dates     

Subsistence:

$ amount      month/year dates     

Personal Equipment/Supplies:

$ amount      month/year dates     

Total:

$ amount      month/year dates     

Explain the reasons for the requested budget allocations.

     

NAME:      

OTHER GRANTS applied for to support this trip or project.

1. Name of fund:      

Purpose (e.g., salary, supplies, etc.):      

Dates:      

Amount requested:      

2. Name of fund:      

Purpose (e.g., salary, supplies, etc.):      

Dates:      

Amount requested:      

List all grants received and honors won within the past five years, indicating the amounts received and the 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 website, forward it to your letter writers, and notify them of the deadline for which you are applying; confirm with them that the letters have been sent in time.

name

     

brief address

     

name of institution

     

telephone

     

email

     

name

     

brief address

     

name of institution

     

telephone

     

email

     

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@. 6/2017

................
................

In order to avoid copyright disputes, this page is only a partial summary.

Google Online Preview   Download