Appendix I: Shale Gas Collaboration and Travel Program
Application Cover Sheet
GENERAL PROJECT INFORMATION
Total Amount Requested
Dates of Proposed Visit
Topic of investigation to be carried out by applicant (up to 25 words):
INFORMATION ABOUT THE APPLICANT
Full Name
Position/Title
Institution Name and Mailing
Address
Institution Director Name
Institution Director Telephone #
Institution Director Email
Date of Birth (MM/DD only)
Passport Number
Country of Citizenship
Country of Residency
Sex (Male or Female)
Highest Degree Earned
Field of Degree
Year Awarded
Telephone #
Fax #
E-Mail
Please list program and grant number of past or current grants
received from CRDF
Are you currently an undergraduate or graduate student at an
YES
NO
institution of higher education?
If “Yes,” please explain what type of degree program you are in and specify when you expect to complete your current
studies in the space below.
Do you have research experience in weapons-related subjects?
YES
NO
Have you visited Poland or Ukraine before?
YES
NO
If “YES,” provide a brief description of the reason for your previous visit:
SIGNATURES
By signing this application, I certify
(for Applicant): that I meet all the eligibility requirements in this announcement and that I will honor all
conditions of the program.
(for Applicant’s Institution representative): that my organization supports the proposed project and will
grant the applicant time away from his/her home laboratory to carry out the proposed visit.
Applicant
Date
Applicant’s Institution
Director or Institutional
Representative
Date
1
Appendix II: Sample Institutional Letter of Guarantee
[DATE]
John Hurley
Vice President
CRDF Global
1776 Wilson Blvd. 3rd Floor
Arlington, VA 22209
Dear Mr. Hurley:
This letter represents a commitment by [host institution] to support [name of applicant]
for [his/her] application submitted to the CRDF Global’s Shale Gas Collaboration and
Travel Program. [Host institution] will provide access to the facilities and equipment
required to carry out the project.
Sincerely,
Host Institution Representative
2
Appendix III: Budget
Category
International Transportation 1
Amount Requested from CRDF
Global
Support from other
sources
Visa Fees
Health Insurance 2
Per Diem (Including Lodging) 3
Ground Transportation 4
Materials and Supplies
Total Amount 5
1
Air ticket price should reflect the lowest-cost applicable airfare offered by a U.S. carrier for
an economy class, round-trip ticket between the country of origin and the designated research
location. Flight itineraries must be approved by CRDF Global prior to ticket purchase.
2
Emergency health insurance is mandatory for all travelers. CRDF Global will purchase the
insurance directly and the expenses will be charged to the award. Estimate emergency health
insurance cost of $75 should be budgeted for each week of foreign travel.
3
For travel of two weeks or less, living allowances should follow U.S. government per-diem
guidelines. Applicants should refer to the following website:
http://aoprals.state.gov/web920/per_diem.asp. For visits of more than two weeks, applicants
may request up to $3,000 per month or the prorated equivalent.
4
Reimbursement upon presentation of receipts.
5
The total request is not to exceed $10,000.
3