Grant Submission – Pennsylvania Academy of Science

First Student

Student First Name *

Student Last Name *

Student Email *

Co-Author Student

Co-Author Student First Name

Co-Author Student Last Name

Co-Author Student Email

Faculty Mentor/Sponsor

Faculty Mentor/Sponsor First Name *

Faculty Mentor/Sponsor Last Name *

Faculty Mentor/Sponsor Email *

My advisor will be able to review grants for the Academy * YesNo

Faculty Mentor/Sponsor Mailing Address

Address *

City *

State *

Zipcode *

Grant Information

Grant Title *

Grant Abstract *

Grant Area *

Amount of funding requested ($)*

Institution/College/university *

Animal Use

Will vertebrate animals be used? * YesNo

Date of IACUC approval

Other institutional approvals

Were additional institutional approvals required for the proposed research? * YesNo

Institutional approval IRB approval for the use of human subjects has been obtained.Biosafety Review Board approval has been obtained.

If the required approval was not obtained, please provide reasons for any exemptions to the required approvals.

Grant proposal upload (pdf, doc, or docx format; size limit:5MB)*