| Contact Information | |
| Last Name: | First Name: |
| Class: | Department: |
| Participants Information
(Name, Class, Department) |
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| Goal of Activity
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| Detailed Plan
(use attachments if space not enough) |
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| Estimated Expenses
(use attachments if space not enough) |
|
| How Would the Achievements Be Publicized
(publish articles, distribute reports, etc.) |
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| How Would You Use the Grant:
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| Signature: | Year/Month/Date: |