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Bergstrom Award Application Form

Applicant information

First Name *

Last Name *

Are you a member of AFO? *YesNo

GenderWe collect this information to understand who is accessing our events and awards as part of our work to deliver inclusive programs that appeal to everyone in our community. Only AFO Council and grant reviewers can see this information.

Current student status *Note: Ph.D. students studying at U.S. and Canadian institutions are NOT eligible to receive a Bergstrom Research Award

Institution *Your university or institution

Email Address *

Phone *

Street Address *

City

State/Province

ZIP / Postal Code

Institution's Country The country where your university or institution is located

Study Information

Title of study *

Amount of funding requested from AFO

USD

Not to exceed $1,500 USD

Starting date *

Anticipated duration of study *

Language of the proposal *EnglishSpanishPortuguese

Reference information

Name of primary research supervisor (if any)

Is supervisor a member of AFO?YesNo

Name of person supplying reference letter *

Reference's phone number *

Reference's email address *

Attachments

Attachment 1/3: Applicant's CV *

No file chosen

A curriculum vita no longer than two pages in length summarizing academic degrees, relevant employment history, current position, and any publications

Attachment 2/3: Research Proposal *

No file chosen

A research proposal, not exceeding three single-spaced pages, which describes the purpose of the study and its significance, contains a brief description of the methods to be used, and includes any critical, supporting citations

Attachment 3/3: Budget *

No file chosen

A budget itemizing total costs for the proposed project and indicating the amount you are requesting in the form of a Bergstrom award (not to exceed $1,500 USD)

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