2011 Application for Grant FundingThe Explorers Club

For which grant are you applying? (Check one): Incomplete and/or applications made to wrong program will be automatically disqualified without further review or comment.

Youth Activity Fund for high school students and college undergraduates, fosters a new generation of explorers dedicated to the advancement of scientific knowledge of the world. Awards

typically range from $500-1,500. A few grants may be awarded up to $5,000.

What degree are you currently working towards?

High School (HS) Undergraduate/Baccalaureate (i.e. BA/BS) Other:

OR

Exploration Fund, for graduate and post-doctoral students, provides grants in support of exploration and field research for those who are just beginning their research careers. Awards typically range from

$500-1,500. A few grants may be awarded up to $5,000.

What degree are you currently working towards? Masters (i.e. MA/MS) Doctorate/Post Doctorate (i.e. Ph.D./Ed.D.) Other:

Have you been funded by The Explorers Club Youth Activity Fund or Exploration Fund before?

YES NO Name of Project & Date:

How did you learn about The Explorers Club Grants? Explorers Club member-name Professor/teacher-name:

Explorers Club Website Other:

DEADLINE: 5:00 PM Eastern Standard Time, December 1, 2010AWARDS WILL BE ISSUED IN EARLY APRIL. SUCCESSFUL APPLICANTS WILL BE MAILED

A CHECK TO THE ADDRESS LISTED ON THIS APPLICATION.

ALL REQUIRED MATERIALS MUST BE SUBMITTED TOGETHER EITHER BY MAIL OR ELECTRONICALLY AS ONE PDF OR WORD DOCUMENT. PLEASE MAKE A COPY OF THIS

APPLICATION FOR YOUR FILES.

DO NOT SEND RECOMMENDATION LETTERS SEPARATELY.

We must have a COMPLETE application in order to begin the review process. Take a moment to review the instructions and policies on this form. Please provide all requested information completely and succinctly. Incomplete applications will not be considered. Reviewers depend on the information in this form and letters of reference to evaluate an applicant’s qualifications. The material submitted becomes the property of the Explorers Club and will not be returned.

Send your application via email, mail or fax: alee@explorers.org

The Explorers Club Tel: (212) 628-8383 Attn: Annie Lee Fax: (212) 288-4449 46 East 70th Street

For help with this form contact Matt Williams at 212.628.8383 or email mwilliams@explorers.org. Page 1 of 4

  

     

  

    

      

     

       

Application for Grant Funding

New York, NY 10021, USA

PART I – APPLICANT CONTACT INFORMATION Note: Please Type or Print Clearly

Last Name:       First Name:       Middle Initial:      Address Line 1:      Address Line 2:      City:       State/Province:       Postal Code:      Country:      

Home Phone:       Work Phone:       Mobile:      Fax:      Email:      Personal url or website:      

PART II – PERSONAL INFORMATION

Date of Birth :       Place of Birth :       Citizenship:      Gender:      

PART III – AFFILIATION AND SUPERVISION NOTE: SUPERVISOR IS REQUIRED TO WRITE YOUR LETTER OF REFERENCE, AND SHALL HAVE ONGOING OVERSIGHT OF YOUR RESEARCH AND REPORTS.

Supervisor Name:       Title:      Institution:      Address Line 1:      Address Line 2:      City:       State/Province:       Postal Code:      Country:      Telephone:       Email:      

PART IV – APPLICATION DETAILS

Project Title:      Amount Applied For ($U.S.):       Dates of Project:      Country of Research:      Individual or Group Project:      Organizations Affiliated With Project:      

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Application for Grant Funding

PART V - REQUIRED ATTACHMENTS £ 1. Give a brief (one page only) description of your project, with particular attention to scientific

objectives. Include names and qualifications of your project associates and the specific site(s) of the proposed research. Maps or diagrams may be attached if needed. Personalized descriptions are preferred.

£ 2. Please submit an outline of your project’s budget with a breakout of other funding. Please limit to one page.

a. Applicants may submit budget for awards ranging from $500 to $5000. Budget should equal or exceed amount of award, but should indicate if willing to accept smaller award should your application be eligible for an amount less than applied for.

b. Please check box if willing to accept smaller award. £ No £ Yes c. Will any part of this award be used to pay for participation in any aspect of a program

based in or sponsored by another foundation/institution/not-for-profit organization?

YES NO If yes, name of organization

£ 3. Please give a brief (one paragraph) description of your career objectives and aspirations and discuss how this project fits into that plan.

£ 4. Ask your Supervisor/Advisor to review all of your submission materials and prepare a letter of recommendation. NOTE: The letter must be submitted with the application.

£ 5. Include copy of current Student ID. Student ID must show current date of enrollment. If card does not show proof, please send most recent transcript or other document proving current affiliation with academic or research institution.

£ 6. Are you a Student Member of The Explorers Club? Note: Membership is not required, but is recommended. YES NO Pending

Membership application is at: www.explorers.org

PART VI – AGREEMENT

Project Report Requirement The applicant agrees to submit a written report and statement of expenses, including copies of any receipts, to the Explorers Club no later than six (6) months after field work is completed. The report may be waived if results are to be published in a reputable publication within one year. Publications based on work supported in whole or in part by the Explorers Club are to credit the Explorers Club Youth Activities Fund or Exploration Fund for aid received. The report should be composed to inform the membership and patronage of the Explorers Club of fieldwork so that, at the Club’s discretion, it may be posted on its website, published in The Explorers Journal or The Explorers Log, and used for educational and fundraising activities. A copy of the publication should be submitted to the Club at the address on the front page of this application. Supervisor is liable for failure to submit final report. Failure to meet foregoing report requirement may result in an award reimbursement demand from The Explorers Club.

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Application for Grant Funding

Unused Funds It is understood that any unused portion of the award will be returned to The Explorers Club Youth Activity Fund or Exploration Fund. Funds must also be returned if a project is cancelled or postponed. The Explorers Club will determine if funding will be awarded to revised projects.

By initialing here you acknowledge and agree to the terms set forth in this Section VI.

PART VII – RELEASE NO GRANT WILL BE GIVEN UNLESS A PROPERLY COMPLETED RELEASE IS SIGNED

I,       of,       (Name) (University or sponsoring institution)

for the project,       (Title of Proposal or Field Expedition)

do hereby release the Explorers Club to the fullest extent permitted by law, for myself, my heirs, administrators, executors and assigns from any liability for damages from illness, injury and/or death arising out of, or connected with, or in any manner pertaining to said grant or project whether caused by negligence or otherwise.

Applicant: ________________________________ Date: _______________

Parent/Guardian: ___________________________ Date: _______________(For applicants 18 years or younger)

Print Name:

Address:

PART VIII – SIGNATURES Note: Applications must be signed by hand. We do not accept typed signatures.

Applicant: ____________________________ Date: ____________

Supervisor: ___________________________ Date: ____________

Parent/Guardian: _________________________ Date: ____________(For applicants 18 years or younger)

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