Application

EXPLORERS CLUB WASHINGTON GROUP

EXPLORATION AND FIELD RESEARCH GRANTS PROGRAM

APPLICATION FORM

Name of Applicant:_______________________________________________________

Address for correspondence: ________________________________________________

________________________________________________________________

________________________________________________________________

 

Daytime Telephone Number: ________________________________________________

Mobile Phone Number, if preferred:  ________________________________________________

E-Mail Address:      _______________________________________________________

Date of Birth: ____________________________________________________________

Educational Institution: ___________________________________________________

Address (if different from above): ____________________________________________

___________________________________________________________________

 

___________________________________________________________________

Graduate Supervisor of the Applicant: _______________________________________________

Address: ________________________________________________________________

________________________________________________________________

 

 

Daytime Telephone Number: _________________________________________________

 

E-Mail Address:      ________________________________________________________

 

Title of the Project: _______________________________________________________

________________________________________________________________

 

Duration of the Project: ___________________________________________________

 

Location of the Project:   ___________________________________________________


EXPLORERS CLUB WASHINGTON GROUP

EXPLORATION AND FIELD RESEARCH GRANTS PROGRAM

 

APPLICANT’S CURRICULUM VITAE

 

Name: _________________________________________________________________

 

Undergraduate Education:

Institution: ______________________________________________________________

Degree and Date Conferred: ________________________________________________

Major/Minor: ____________________________________________________________

 

Graduate Education:

Institution: ______________________________________________________________

Department:  ____________________________________________________________

Thesis Advisor: __________________________________________________________

Degree and Date Expected: _________________________________________________

Title of Thesis Research: ___________________________________________________

 

Additional Graduate or Undergraduate Education, if any:

Institution: ______________________________________________________________

Department: _____________________________________________________________

Description: _____________________________________________________________

 

Awards within the Past 3 Years: _____________________________________________

_________________________________________________________________

 

_________________________________________________________________

 

List of your Publications (Use an attachment, if necessary):

_________________________________________________________________

 

_________________________________________________________________

 

_________________________________________________________________


EXPLORERS CLUB WASHINGTON GROUP

EXPLORATION AND FIELD RESEARCH GRANTS PROGRAM

ABSTRACT OF THE PROJECT:

Do not exceed 200 words. Please use the narrative form.

Applicant’s Name: ______________________________________________________

Title of Project: _______________________________________________________

_______________________________________________________


EXPLORERS CLUB WASHINGTON GROUP

EXPLORATION AND FIELD RESEARCH GRANTS PROGRAM

 

PROJECT DESCRIPTION

(Do not exceed 3 pages):

Describe the Project, and include:

  1. The overall objectives of the Project
  2. Your role in the project
  3. The significance of your participation in the project (if you are participating in a project led by others)
  4. The significance or expected impact of the overall project (Note: Your project will be reviewed by a team of individuals with a broad range of expertise, so placing your project in a context of broader significance will be of interest to those outside your discipline.)

 


EXPLORERS CLUB WASHINGTON GROUP

EXPLORATION AND FIELD RESEARCH GRANTS PROGRAM

BUDGET

(Note: Most awards range from one to several thousand dollars)

 

Please provide a budget breakdown with costs listed per item

Attach a list of current support (include source and amount)

Attach a list of pending grants (include source and amount)

 

 


EXPLORERS CLUB WASHINGTON GROUP

EXPLORATION AND FIELD RESEARCH GRANTS PROGRAM

RECOMMENDATION FORM

Name of Applicant: _____________________________________________

Referee: _______________________________________________________

Address: _______________________________________________________

_______________________________________________________

 

_______________________________________________________

Signature: ______________________________Date: __________________

Telephone Number: ______________________________________________

E-mail: ________________________________________________________

 

Please include information on how long you have known the applicant and in what capacity; how the proposed project will further the goals of increasing knowledge in the areas of exploration and field research and how participation in the proposed project will contribute to the development of the applicant’s career or make a contribution to the field. Attach additional pages as needed.

Please send the recommendation letter to ecwggrantsprogram17@gmail.com  Please ensure that the student’s name is in the subject line.

 

 

SUBMISSION DEADLINE: February 3, 2017

 

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