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I am applying for:
College Alumni Society Research Grant – October
College Alumni Society Research Grant – March
Class of 1971 Robert J. Holtz Fund
Vagelos Undergraduate Research Grant
Penn ID Number:
School (select all that apply using CTRL+click):
Engineering & Applied Sciences
Liberal & Professional Studies
Current overall GPA:
Expected Graduation Year
Local Phone Number:
Proposed Project Title:
Funds Requested ($):
Identify Other Opportunities for Support, if any:Write Here
As per my rights under the Family Educational Rights and Privacy Act of 1974, it is my desire that this recommendation be:
I understand that my choice of confidentiality or non-confidentiality may be communicated to my recommender, and that I waive all rights of access to this reference if I choose confidentiality.
Faculty Recommender (first name):
Faculty Recommender (last name):
Faculty Recommender’s Department
Faculty Primary School Affiliation:
Arts and Sciences
Engineering and Applied Sciences
Social Policy and Practice
Faculty Recommender’s email:
Your Undergraduate Chair or Program Director:
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:
Short Abstract; Objectives & Methodology; Itemized Budget; Penn InTouch Transcript. 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.
Is the project affiliated with a course or independent study? Please give course number:
By clicking “submit” I am acknowledging that my PennKey will act as my signature.
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