Proposal Title:
Applicant Information Academic Advisor or Person Responsible for Project
Name:
Affiliation:
Affiliation Address:
City:
State:
Select State
AL
AK
AZ
AR
CA
CO
CT
DE
DC
FL
GA
HI
ID
IL
IN
IA
KS
KY
LA
ME
MD
MA
MI
MN
MS
MO
MT
NE
NV
NH
NJ
NM
NY
NC
ND
OH
OK
OR
PA
RI
SC
SD
TN
TX
UT
VT
VA
WA
WV
WI
WY
Other Country
Zip:
Phone:
Fax:
Email:
Category:
Select
Post-Doc
Scientist
Grad. Student
Faculty
Undergrad
Other (Specify)
If Other, please specify:
Do you require special assistance?
Select
Yes
No
If Yes, please specify:
Project Information
Describe your research project
Total Project Cost Estimate:
Expected Start Date:
Expected Finish Date:
How many users will be involved?
At which MRFN Facility do you expect to conduct your experiments/tests?
Select
UCSB
UMASS
UMN
USM
UWM
Uncertain
Please clearly identify all sources of income for your
project.
a. University Funding
Amount Applied for:
Amount Received:
b. Government Funding
Amount Applied for:
Amount Received:
c. Private Sector Funding
Amount Applied for:
Amount Received:
d. Other Funding
Amount Applied for:
Amount Received:
e. MRFN Funding
Amount Applied for:
Amount Received:
Total Income
What aspects of your research do you expect MRFN Funding to assist?
(Instrument usage fees, travel costs, housing costs, etc.)
Declaration of Interest
Are you aware of any personal or professional relationship with any Faculty, Staff, or Board Member of any MRFN Member University?
Select
Yes
No
If Yes, please specify:
BY SUBMITTING THIS FORM, I AGREE TO THE FOLLOWING:
I have the power to accept any awards offered, depending on the conditions shown, and to repay the award if I do not meet these conditions.
I understand that any awared offered may be publicized by MRFN.
I confirm that the information I have given is true and I have answered all the questions on the form. I will let you know immediately if any of the information I have provided changes.
MRFN will take legal action to recover funds from any applicant who has provided fraudulent information in the application.