Center for Undergraduate Research and Fellowships

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I am applying for:

First Name:

Last Name:

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:

Proposed Project Title:

Funds Requested ($):

Identify Other Opportunities for Support, if any:
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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:

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.