Application for Undergraduate Res
earch Poster/
conference Funding
RESEARCHERS
Student 1:
First name: ________________________________ Last name: ________________________________
Email: ________________________________ Phone: ________________________________
Student 2:
First name: ________________________________ Last name: ________________________________
Email: ________________________________ Phone: ________________________________
Faculty Sponsor:
First name: ________________________________ Last name: ________________________________
Email: ________________________________ Phone: ________________________________
Department: _________________________________________________________________________________________
Other students or faculty:
POSTER INFORMATION
Project Title:
Where will you be presenting your poster?
Presentation date/s:
Agreement to present at the Celebration of Scholarship
In exchange for funding, the research committee requires you to present your research
progress and/or findings at the Celebration of Scholarship in April of the funding year.
Signature of person completing application form : ______________________________________
Please submit this form by email attachment to Dr. Wendy L. Wilson,
wendy.l.wilson@dickinsonstate.edu.