Institute of Hazardous Materials Management
11900 Parklawn Drive, Suite 450
Rockville, MD 20852

Research Grant Program Application Form
Complete this form and submit it (with any attachments) to the above address.

 

 

 

 Name: ______________________________________________ E-mail: ______________________

 

 Address:  ________________________________________________________________________

 

 ________________________________________________________________________________

 

 Phone  (Day)__________________ (Evening) ___________________  Fax #: ___________________

 

 

(Please answer all questions. Please type or print. Attach additional sheets if needed, and number entries to correspond to this form.)

 

1.     Name, address, and department of the University where research is to be conducted:

 

 

 

2.     Degree being pursued by the applicant:

 

 

3.     Name and telephone number of the University professor who is acting or will act as the applicant’s research advisor:

 

 

 

4.   Description of the proposed research

         a.   Topic to be researched:

 

  

 

 

 

         b.   Objectives and scientific or policy significance of the proposed work:

 

 

  

 

 

      c.   The proposed research method and the rationale for selecting this method:

 

 

 

 

 

 

 

      d.   Research timetable:

 

 

 

 

 

      e.   Amount of funds requested from IHMM and the intended use of the IHMM grant funds
           (attach a detailed budget): 

 

 

 

5.         Qualifications of the applicant and the University professor serving as the applicant’s research advisor:

 

 

 

 

6.         It is IHMM's desire to fund research that will enhance the field of hazardous materials management.  In your own words, tell us why you believe your research will enhance the field.  (An answer of approximately 100 words or less is desired.):

 

 

  

 

 

Signatures

I attest that the information stated in this application is true and complete to the best of my knowledge:

 

 

___________________________________________________     _____________________________

Signature of Applicant                                                                                     Date

 

 

I attest that the research described in this application is to be conducted under my supervision and as part of the applicant’s degree program:

 

 

____________________________________________    __________________________

Signature of Research Advisor                                                                       Date