Application for a
2013 IPE SUMMER RESEARCH FELLOWSHIP
To be submitted to Reggie Tison, IPE Secretary, McIntyre 213, by 12:00 noon on February 20, 2013
Name ___________________________________________________
CMB _________________
UPSID _________________
E-mail Address
Telephone
Faculty Research Supervisor
Research Project Title
Summary of proposed research
Does your research involve the use of human participants?
Yes
No
If yes, please see Section 3, pages 8 -10 of document entitled Institutional Review Board (IRB) for the
Protection of Human Subjects: Principles and Procedures Governing the Use of Human Subjects in Research
(available at http://www.pugetsound.edu/academics/faculty--staff-resources/institutional-reviewboard/) to determine whether your research will require “full IRB review,” is eligible for “expedited review,”
or is “exempt” from review.

If exempt, please include a statement of exempt approval status from the departmental IRB designate
(normally, the IPE Director) as explained on page 10 of the IRB document.

If requiring expedited or full board review, please include a copy of all completed and approved IRB
materials with your Summer Research Fellowship application.
Does your research involve traveling outside of the United States? Yes
No
If yes, make an appointment with Associate Dean Lisa Ferrari to discuss your travel plans. The Associate Dean
will give instructions concerning all formal documents that must be completed as part of your research grant
application. Please have the Associate Dean sign below to verify the completion of all needed
documentation.

The University of Puget Sound does not support travel to countries currently on the Department of State’s
travel warning list and on the Centers for Disease Control’s travel health warning list.
Name of country if applicable
Signature of Associate Dean (to verify completion of documents for students
whose research involves travel outside U.S.)
Date
As the faculty supervisor, I approve this student’s research proposal and will advise this student’s project during
the summer, 2013.
Faculty Research Supervisor’s Signature
Date
Checklist for a complete application
Cover page, with all signatures
Project statement (no more than 2 single-spaced pages, 12 pt. font)
Personal statement (no more than 2 single-spaced pages, 12 pt. font)
Letter of recommendation from faculty research supervisor
Puget Sound transcript
IRB approval (if necessary)
Travel documentation (if necessary)
If awarded a fellowship, I agree to provide a written report to my faculty supervisor and to the Director of the IPE
Program no later than September 20, 2013.
Student's Signature
Date