Research Relations Fund Application

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Cover and Budget Page

Applicant:
Name:
Title & Department:
Phone Ext:
Date:
Title of Project:
Budget Summary:

Time period from to .

Item Amt. Requested from Res. Rel. Fund Other Sources Total
Salaries & Wages*:
Benefits:
Equipment (itemize):
Supplies (itemize):
Travel (specify):
Other (itemize):
Total:

Certifications:

Investigator: ___________________________________________________ (signature & date)

Department/Division Chair: ______________________________________ (signature & date)

Dean/Director: _________________________________________________ (signature & date)