Application Form for CISAB Summer Research/Field Course/Internship Scholarship

Application Deadline: March 15, 2017, 5 pm

Applicants should request an OnCourse DropBox account by emailing before applying and should indicate the name and email address of the faculty recommender.

You will receive an email with a link to your DropBox folder. Submit your application as a single Word or pdf file to the DropBox. Use the following format: Lastname_Firstname_2017.docx (or .pdf). Your recommender will receive a separate DropBox link for their letter. You will not have access to the letter.

Application Date: Click here to enter a date.

Name: Click here to enter text.

IU ID Number (NOT your social security number): Click here to enter text.

IU Email Address: Click here to enter text.

Local Address (Street, City, State, Zip): Click here to enter text.

Permanent Address (Street, City, State, Zip): Click here to enter text.

Phone Number (Work, Home, Cell): Click here to enter text.

Expected Graduation Date: Click here to enter a date.

What are your major and minor(s): Click here to enter text.

Check all the semester(s)/session(s) in which you will be enrolled in classes at IU Bloomington:

☐ Spring 2017☐I-Summer 2017☐II-Summer 2017

☐Fall 2017☐Spring 2018

Will you receive course credit at IU or another university for the experience? If so, specify.

What is the name and email address of your faculty recommender? Click here to enter text.

Affirmation:

☐ Check here to affirm that all of your application materials are true, complete, and accurate, and that they meet the ethical expectations outlined in the IU Code of Student Rights, Responsibilities, and Conduct (http://www.iu.edu/~code/code/responsibilities/index.shtml).

Authorization to Review Academic Records:

☐Check here to authorize the CISAB steering committee and its representatives to review your academic record and your application materials.

Costs: Provide an accurate accounting of the allowable costs for your internship, field course, or research experience. Allowable costs include airfare or other appropriate travel to the internship/course site, tuition or fees for the course, room and board at an internship/course site, or required scientific supplies. Recipients of the award will be required to provide documentation of actual costs.

Other funding sources: Indicate other sources of funding you have applied for that might pay for the proposed internship, field course or research experience.

Briefly (500 words or less) describe your career goals, your background and interests in animal behavior, the proposed summer course or internship, and how the experience will enhance your career and educational goals.

Attach a Resumé or CV here.

CISAB Summer Scholarship ApplicationPage 1