PURA Selection Process

Fields marked with * are required.

PURA Application for Summer 2013/Fall 2013

Summer 2013 Fall 2013

Student information

Mr. Ms.

Name*

Phonetic Spelling of Name*

Campus Address

Street Address

City

State

Zip

Off-Campus Address

Street Address*

City*

State*

Zip*

E-mail*

Mobile Phone

Please be sure to contact the Office of the Provost with changes to your address, e-mail, or phone number. Call 410-516-8770 or e-mail pura@jhu.edu.

School*

Major*

Current Class Year*

NOTE: Seniors are not eligable for Provost's Undergraduate Research Awards.

Research Project Title*

Faculty Sponsor for this Project*

Faculty Sponsor's School*

Faculty Sponsor's Department*

Faculty Sponsor's Campus Address*

Faculty Sponsor's Phone Number*

I am applying for:*

Credit Stipend

If stipend, total amount of funds requested (including stipend). Put zero if not needed.*

Does your research involve human subjects? Please check this link for guidelines: http://web.jhu.edu/Homewood-IRB/applications.html*

Yes No

Have you submitted this proposal to any other individual or organization?*

Yes No

If yes, where?

Proposals should use Times New Roman, Arial, Helvetica, or Verdana fonts, size 11 or 12, and should not exceed 3 pages.
Please make sure that your proposal has your name, title of the proposal as well as the name of your advisor.

Attach/Upload Proposal*

Attach/Upload 2

Electronic Signature

By typing your name in the electronic signature box below, you are electronically signing your name to confirm your acceptance of the following statement:
If selected to receive a Provost's Undergraduate Research Award, I agree to complete the research project described herein. I agree to abide by any and all university procedures as applicable to human and animal subjects.

Signature*

Questions concerning this proposal should be directed to the Office of the Provost at (410)516-8770 or pura@jhu.edu.