Center for Undergraduate Research and Fellowships

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First Name:

Last Name:

Penn Email Address:

Penn ID Number:

School (select all that apply using CTRL+click):

Current overall GPA:

Primary Major:

Secondary Major:

Expected Graduation Year

Address 1:

Address 2:

City:

State:

Zip Code:

Local Phone Number:

Penn Email:

Project Country:

Proposed Project Title:

Funds Requested ($):

Please request a letter from a member of Penn’s faculty who can speak to your ability to carry out this project in the location you propose. Complete the Recommendation Confidentiality Form listed on the previous page.

Faculty Recommender (first name):

Faculty Recommender (last name):

Faculty Recommender’s Department:

Recommender’s e-mail:

Faculty Primary School Affiliation:

In order to expedite transfer of funds, we need the contact information of the business administrator for your primary major.

Business Administrator (first name):

Business Administrator (last name):

Business Administrator Department:

Business Administrator email:

Business Administrator Phone:

Please ask your local project affiliate to write a letter stating their willingness to work with you and briefly describing how they will assist you, and then instruct them to submit it to us via: http://www.upenn.edu/curf/non-penn-faculty-recommendation

Affiliation name:

Affiliation title:

Proposal Essay, Budget, Bibliography, and PennInTouch transcript copy— please name this file using your pennkey name. Please submit one .pdf file. Docx, doc, png, jpg, htm, html, or any other non-.pdf format will be grounds for non-consideration of your application. Name your file with your PennKey name only (the alpha characters, not your PennID Number). Transcripts must be non-secured versions; secured versions prevent us from reading your application and thus will cause your application to be refused.