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					                                    NASA West Virginia EPSCoR
                                      Travel Grant Program
                                    2010-2011 Application Form

NASA WV EPSCoR Program is pleased to provide support to researchers at West Virginia colleges and
universities to travel to NASA field centers or NASA headquarters to meet and initiate collaborative
projects with NASA scientists. Applicants can also request funds to invite prominent researchers to their
campus to participate in research colloquia or to discuss collaborations. Each applicant may request up to
$1,000 of NASA WV EPSCoR funds to be supplemented with at least a one-to-one cost share from the
applicant’s home institution. A brief summary of the event/activity and expense report will be required at
the completion of the proposed activity. Please do not exceed the space provided on the attached form.
Applications will be reviewed on an on-going basis. NASA funds may be used only to directly benefit U.S.
citizens.

Please send one hard copy of your proposal to the following address:

                 NASA West Virginia Space Grant Consortium/NASA WV EPSCoR
                             G-68 Engineering Sciences Building
                                         P. O. Box 6070
                                Morgantown, WV 26506-6070
                                  Telephone: (304) 293-4099
                                   http://www.nasa.wvu.edu




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                                         NASA WV EPSCoR
                                        Travel Grant Program
                                      2010-2011 Application Form

Investigator:
Signature:
Institution:
Address:


Phone:
Email:

1. Purpose and justification of the proposed activity (e.g., Travel to Johnson Space Center to meet
   with Dr. Lee to establish research ties):




2. Funding Requested from NASA WV EPSCoR:
    Institutional Cost Share:
    Total Budget:
    Brief budget explanation:




3. Date(s) and schedule of proposed activity:


4. Institutional representative certifying availability of cost share funds:

Name:                                                                  Date: __________________
Title:
Signature:
Telephone:
Email:
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