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* Email address

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* Name

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* Institution

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* Major(s) and Minor(s)

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* Which of the following best describes you? (Choose all that apply)

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* Faculty Research Mentor Name

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* Faculty Research Mentor Email

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* Date that funds are needed

Date

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* Title of research project

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* Abstract of Research Project (300 word maximum)

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* Total Amount requested (please provide dollar amount)

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* Itemized budget and justification (list $ amounts for each requested item and describe why it is needed)

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* Please provide the dollar amount that your department/institution will give you to support your research

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* In 500 words or less describe why you are seeking an URSA and how you will benefit from the experience

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* Do you agree to submit the following to curmember@cur.org within 90 days of receiving funds?

(1) Copy of the poster/talk/paper that the funding supported
(2) Description of the experience (250 words or less)
(3) Photo or graphical image with a caption and credit

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* Do we have your permission to use the information and materials you provide us on our webpage, Facebook page and/or newsletter? *

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