NSF I-Corps Funding Application

PART I: Requestor
Requestor is:*
- University of Rochester - Individual Student
- University of Rochester - Student Team
- Non-UR - Individual
- Non-UR - Team
Name*
First Last
Email*
Phone
Class Year
Program of Study
University Affiliation (if applicable)
Company, Team or Group Name*
Contact Information*
Name Email Phone Class Year Program of Study Role in Group

List all of the above information for all group members. Indicate the group leader in the "Role in Group" column.
Contact Information*
Name Email Phone Role in Group University Affiliation (if applicable)

List all of the above information for all group members. Indicate the group leader in the "Role in Group" column.
What team name did you participate under through NSF I-Corps and what semester and year did you participate in I-Corps?
Do you need to know about the status of your request by a certain date? If so, enter it below.
MM slash DD slash YYYY

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PART II: Details of Request
Reasons for Requesting Funds*
Describe the details of your request. Include goals, projected outcomes and planned evaluation methods.
What is the nature of your expenses?*
For example, do you plan to use this funding for printing, shipping, supplies, materials, travel, etc.? If travel, include intended method of travel and lodging details. If vendors or contractors will be used, include as much of their information as possible.
Logistics
Please include this information if you intend to use the funding for a specific event or for travel.
Date(s) Time(s) Location(s)

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PART III: Breakdown of Funds
Total Funds Needed ($)*
Itemized Budget Outlining Use of Funds*
Expense Name Description Permitted Expense Type (Materials and Supplies; Meetings and Conferences; Transportation; Travel Costs; Contractors) Estimated Cost Purpose

Under Permitted Expense Type, you must select one of the five expense type categories.

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Signature*
By signing in the box, you certify your eligibility for this funding to the best of your knowledge and agree to adhere to the financial guidelines.

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PART I: Requestor

Name	Email	Phone	Role in Group	University Affiliation (if applicable)

Expense Name	Description	Permitted Expense Type (Materials and Supplies; Meetings and Conferences; Transportation; Travel Costs; Contractors)	Estimated Cost	Purpose

Date(s)	Time(s)	Location(s)