Pacific ID #______

University of the Pacific

2017Undergraduate Summer Research Fellowship Application
Deadline: March 24, 2017 by 3 PM

Please complete this form electronically

(forms completed by hand will not be considered)

Submit electronically to Dr. Lydia Fox ()
or in hard copy to the Office of Undergraduate Research (Knoles 202B)

Student Information
Last Name
First Name
Pacific ID#
E-mail
Address
(non-campus location where the award check can be sent)
Phone
Faculty Mentor Information
Last Name
First Name
Department
Campus Phone
E-mail
Project Information
Title of Project
Have you received funding from the Office of Undergraduate Research previously? Yes No
If so, when? Which award? Amount?

Are Human Subjects involved? *Yes No *If yes, include approved IRB protocol# ______

“Human Subject” means a living individual about whom an investigator conducting research obtains (1) data through intervention or interaction with the individual, or (2) identifiable private information.

Are live vertebrate animals involved? *Yes No

*If yes, include approved IACUC protocol# ______

This includes animals used or intended to be used in performance, production, research, teaching, testing (e.g., quality control), or other types of experiments.

For questions regarding IRB and IACUC requirements contact

Are hazardous materials involved? *Yes No *If yes, include a letter of endorsement from the Environmental Health & Safety Supervisor

To be completed by the student:

Attach a research proposal (12 point font, 1” margins, single spaced).

The research proposal should contain the following:

a) The full title of your project.

b) Describe your proposed research or creative activity (limit this to 750 words or less).

c) Describe the approach/method you will use to carry out your propped project or creative activity. Explain why this is a reasonable approach that should resulting in a high likelihood of a successful outcome (Limit this to 500 words or less)

d) Describe any relevant academic or work experience and achievements that prepared you for conduction your proposed project/activity. Included and prior related coursework, research and/or creative activity or any skills you acquired from your work experience. (Limit this to 250 words or less)

e) Description of what the expenses funds will be used for.

f) A detailed timeline for the project

NOTE: indicate if you plan to work at a summer job in addition to this project and, if so, how many hours/week you expect to be employed. The expectation is that students will devote a minimum of 8 weeks full-time to the project over the course of the summer. If you are planning on enrolling in any courses during the summer, that should be limited to one summer session.

NOTE: Your proposal must use language that is readily understandable to faculty reviewers outside your discipline, or it will not be considered.

Student Signature:______Date:______

Budget

(to be completed in consultation with the faculty mentor)

Expenses
Item / Amount
Total
Other (describe)
Total
Student Award
($1000 of the stipend will be paid after the final report is submitted) / 3,000
Faculty Award
(will be paid after the final report is submitted) / 1,000
What is the Index Code that the Expense funds will be deposited to?
Does the faculty mentor want their award funds deposited to this account as well? Yes No
Total Requested ($5000 maximum)

To be completed by the Faculty Mentor:

Attach a separate document that includes the following:

  1. Describe how you plan to mentor (support) the student through the proposed activity. Be very specific about how many times per week you plan to meet with your student and describe how you will monitor your student’s progress. (Limit this to 500 words or less)

Note: based on multiple years of assessment data, the more frequent and in-depth the interaction between faculty mentor and the student, the more successful the research experience is for the student.

  1. If either your or your student plan to spend periods of time away from campus (not related to the project), describe how your mentoring plan will address this.
  1. If the student plans to work during the summer, describe what arrangements you have made with the student and how the part-time or full-time job impacts the student’s ability to complete the proposed project.
  1. Provide a description (1000 words maximum) of your professional accomplishments, including any previous and current scholarlyactivities that include undergraduate students. If you have served as a mentor on a previously funded summer undergraduate research fellowship(s), you must provide the following: name of the student(s), brief description of the project(s), and outcome(s) of the project (e.g. presentations, publications, performances, or other activities that resulted from the project, including presentations made at the Pacific Undergraduate Research & Creativity Conference (PURCC).
  1. Provide at letter of recommendation for your student and why you think their proposed project should be funded.

Your signature indicates your assurance that the usage of any humans, animals and hazardous materials have been approved, and that the research will be conducted ethically and under your supervision.

Faculty Mentor Signature:______Date:______

2017SURF Application