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COSMOS SCHOLARS Program (Grants to Graduate Students)
2018-2019 Application Form

All applicants must complete this application form and submit online by midnight EDT on November 1, 2018.

Please note items marked * are required. Enter N/A if not applicable. 

Step 1 of 3

*Prefix:   Mr.    Miss   Ms.   Mrs.   Other (type alternate title here or N/A)
*First Name: M.I. *Last Name: Suffix:
*Street Address:
*City: *State/Region:
*Zip/Postal Code: *Country:
*Primary Telephone: Secondary Telephone (if any):
*E-mail: Fax:
*Enrollment Status: Full-time Part-time
*Degree Sought:
If Other Master Degree selected, please specify:
If Other Doctoral Degree selected, please specify:

*Dissertation/Thesis Title (use proposal title if necessary; do not leave blank or use filler, e.g., N/A):
*Proposal Title:

*Amount Requested: $
Note: use only numbers (e.g., 1200 or 800.85)

*How will the money be allocated?

*Other support, if any, sought or received for proposal:

* My advisor is aware of my proposal and agrees that it is feasible at my institution and is willing to be contacted should the proposal be granted.

*Academic/Faculty Advisor's Name:
*Advisor's Title:
*Advisor's Phone Number: Advisor's Fax Number:
*Advisor's E-mail Address: