Intercollegiate Academics Rearch Fund Request
Cover Sheet

Submit this cover sheet, a one-page narrative description and budget provided to Cheryl Nedrow, Office of the Executive Vice President and Provost, Seerley Hall - Room 1.

Course Number:

Course Title:

Instructor Name:

Title or other designation of the project to be funded:

Total amount of request: $

Additional Funding Sources Applied For:

Note: Requests for funding will not be considered after expenses have already been incurred.

Have you previously received a IAF Research Award?________If yes, give the date:

1. Does the project involve human beings in the research? Yes or no ____

2. If yes, then check one of the following:

a. Approval was granted by the Institutional Review Board (IRB) on _________ (date).   (please attach a copy of the certificate to this application)
b. Application for approval was submitted to the IRB on __ _______ (date) but a response has not yet been received.
c. Review will be sought if the project is funded. ____ (check if yes)

Signatures and dates:

Student(s)___________________________________________________________________

Instructor/ Faculty Adviser______________________ Name: ___________________________

IAF Research Award
Budget

Provide a short description of the item(s) to be purchased or the services requested.  Include cost per item where appropriate.  Similar items can be combined in one line where appropriate.