HARVARD UNIVERSITY
                      DEPARTMENT OF PSYCHOLOGY
UNDERGRADUATE THESIS RESEARCH GRANT APPLICATION

NAME / ID # / E-MAIL ADDRESS:

____________________________________________________________________

HOUSE MAILING ADDRESS/PHONE:

____________________________________________________________________

LEGAL (HOME) ADDRESS:    _____________________________________________

                                                      _____________________________________________

• Social Security number:      ________________________
• Nation of citizenship:          ________________________
• Are you currently on a Harvard payroll?     ____________

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I. COVER LETTER     Attach to application.  A cover letter addressed to the Committee on 
                                        Undergraduate Instruction ("Dear Committee Members,") should be 
                                        several paragraphs that summarize your thesis research and explain 
                                        how the expenses you itemize here will help you carry it out. 

II. HUMAN SUBJECTS APPROVAL - Attach two copies of approval letter from Committee 
                                                              on the Use of Human Subjects.

III. RESEARCH EXPENSES

    Category        Description                                                                                         Cost

            Supplies    _____________________________________________________     ______________

                             _____________________________________________________     ______________

            Photocopying  __________________________________________________     ______________
      
            Subjects     _____________________________________________________     ______________

            Other         _____________________________________________________     ______________

                              _____________________________________________________     ______________

                                	                             TOTAL RESEARCH EXPENSES                  ______________

IV. GRANT REQUEST

     Funding from Supervisor         		                                  ______________

            Other Funding (Sources:  _______________________________________)        ______________

		                               TOTAL GRANT REQUEST                   ______________

            Supervisor Approval of Request


           ______________________________________________________________________
            (Supervisor's Signature)                                		(Date)

Submission:  You may submit this application to the Psychology Undergraduate Office any time after you 
have had your prospectus approved at your prospectus meeting.