COLLEGE OF ARTS AND SCIENCE
OFFICE OF UNDERGRADUATE RESEARCH
RESEARCH & INNOVATION GRANT
Request for Disbursement
Grantee Information:
Legal Name*
Last
First
Middle Initial
Jr., III, etc.
*For non–U.S. citizens: Please use name exactly as it appears on your passport.
Nickname/Preferred Name:
Student I.D. Number
Date of Birth
Campus Address
(m/d/yy)
Class (Graduation) Year
CPU Box Number
Mailing Address (if Different)
Number and Street
Address 2 (if necessary)
City or Town
State
Date of Request
(m/d/yy)
Zip / Postal Code
Academic Term of Fund Use
Country (if other than U.S.)
-
Enter the term during which requested funds will be used. (e.g.: Spring-2014)
A new request must be completed each term, even if for the same project.
Status of Funding (please round to nearest dollar)
Total Grant Amount
$
Funding Disbursements to Date
$
Balance to Date
$
Estimated
Actual (office use only)
Current Estimated Amount Requested
$
$
Estimated Account Balance
$
$
Summary of Expenses
Amount
Requested
Expense Type
Code (see
below)
Stipend/Salary or
Reimbursement for Expenses?
Beginning Date (of employment,
internship, or travel. Leave blank if not
applicable.)
End Date (of employment,
internship, or travel. Leave blank if
not applicable.)
$
$
$
$
Expense Type:
1
2
3
4
Travel Expenses: Summer Term Abroad
Travel Expenses: Winter Term Abroad
Travel Expenses: Conference
Salary/Stipend, Summer Internship
Research & Innovation Grant (RIG) Grant Disbursement Form
7/1/16
5
6
7
8
Salary/Stipend, Research Assistant: Summer
Salary/Stipend, Research Assistant: Academic Year
Research Materials (Reimbursement)
Other (please specify in description on following page)
Please describe each proposed expense listed above in detail. Explain how the expense will be used for your
research, internship, or other approved experience.
Required Signatures
We will not review your disbursement request without the proper signatures.
Faculty mentor signature required on disbursement larger than $100
Student
__________________________________________________ Date
I have discussed the proposed project with a faculty mentor and I certify that the
expenditures above are valid UR business expenses and are allowable for the above account(s).
Faculty Mentor __________________________________________________ Date
I have discussed the proposed project for the above student
Mentor Name (typed)
Mentor Dept.
Questions about Research & innovation Grants can be directed to:
Research & Innovation Grants Coordinator
Office of Undergraduate Research
University of Rochester
4-209B Dewey Hall
Box 278977
Rochester, New York 14627
(585) 276-5306
E-mail: undergradresearch@ur.rochester.edu
For more detailed information about the Research & innovation Grants, visit
http://www.rochester.edu/college/ugresearch/rig.html
The University of Rochester provides equal opportunity in admissions and student aid regardless of sex, age, race, color, creed, disability, sexual
orientation, and national or ethnic origin. Further, the University complies with all applicable nondiscrimination laws. Questions on compliance
should be directed to the particular school or department and/or to the University's Intercessor, University of Rochester, P.O. Box 270039,
Rochester, NY 14627-0039. Phone: (585) 275-9125.
Research & Innovation Grant (RIG) Grant Disbursement Form
7/1/16