UW-Stout Student Research Fund Grant
Application Cover Sheet
This proposal is a (check one):
☐Research Grant Proposal
☐Dissemination Grant Proposal
Contact information for all student researchers involved:
(Attach additional sheet if necessary) (The first name listed in a group will be considered project leader)
Name: Click here to enter text.
text.
Major: Click here to enter text.
Email Address: Click here to enter
Check One:
☐Freshman
☐Sophomore
☐Junior
☐Senior
☐Graduate
College: Click here to enter text.
Signature: ________________________________ Phone Number: Click here to enter text.
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Name: Click here to enter text.
text.
Major: Click here to enter text.
Email Address: Click here to enter
Check One:
☐Freshman
☐Sophomore
☐Junior
☐Senior
☐Graduate
College: Click here to enter text.
Signature: ________________________________ Phone Number:Click here to enter text.
=====================================================
Name: Click here to enter text.
text.
Major: Click here to enter text.
Email Address: Click here to enter
Check One:
☐Freshman
☐Sophomore
☐Junior
☐Senior
☐Graduate
College: Click here to enter text.
Signature: ________________________________ Phone Number: Click here to enter text.
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Project Title: Click here to enter text.
Project Beginning Date: Click here to enter text.
Project Ending Date: Click here to enter text.
Funds Requested from Student Research Fund: $Click here to enter text.
Citation Style Format: ☐APA
☐MLA
☐AMA
☐Other: Click here to enter text.
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Research Involving Human Subjects: If your research involves Human Subjects, please see the
Human Subjects web site.
Have you completed Human Subjects Training?
☐Yes

☐No, not yet
☐No, not applicable to this project
If "Yes," please attach the Certification of Completion of Human Subjects Training.
Has the project received IRB approval?
☐Yes
☐No, not yet
☐No, not applicable to this project
☐No, but Protection of Human Subjects in Research Form has been submitted

If “Yes,” please attach documentation of approval.
Is this a Just in Time (JIT) grant?
☐Yes
☐No
 If "Yes," please explain the reasoning for applying for funding outside the normal grant cycle. Click
here to enter text.
Dissemination Grant Proposals:
Attach a copy of an official acceptance letter to the professional event you are planning to
attend, if applicable. Also, please provide information about the conference such as the
website URL, dates, and location. Click here to enter text.
Check the appropriate box below:
☐I will be presenting individually or with a group of students
☐I will be presenting with my research advisor
 If you will be presenting with your research advisor, your advisor may apply for funding through the
Professional Development fund.
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By signing this form the research advisor agrees to:
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Provide supervision on the research and budget for the proposed project
Review this application prior to signing for content and professional presentation
Assist student with transportation & lodging arrangements and reimbursement (to assure
compliance with University rules/regulations)
Assist student with purchases and reimbursement (to assure compliance with University
rules/regulations)
Complete and submit the Advisor Checklist
Research advisor's name: Click here to enter text.
College: Click here to enter text.
Department: Click here to enter text.
E-mail address: Click here to enter text.
Phone Number: Click here to enter text.
I have reviewed the final proposal and approve this project.
Signature: _____________________________________ Date: ________________
Submissions: A signed paper copy of the application cover sheet must be submitted to:
Research Services, Room 152 Voc. Rehabilitation Building, UW-Stout, Menomonie, WI 54751. An
electronic copy of the grant proposal, as a Word document, must ALSO be sent via email to
studentgrants@uwstout.edu. Please include your name on the Word document.
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