Meliora Scholar Request for Disbursement
Full Name
*
First Name
Last Name
Email
*
UR ID
*
e.g. 12345678 (not your Net ID)
Class Year
Major(s); please enter UNC if uncertain at this time
*
Current Amount Requested
*
Start Date
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Month
-
Day
Year
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End Date
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Month
-
Day
Year
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WHERE will your experience take place?
UR River Campus
UR Medical Center
Other US Location
Other non-US/International Location
Please enter CITY and STATE or COUNTRY of your experience if away from the UR. You may enter multiple locations, if applicable.
How would you classify your experience or fund use? Please check all that apply.
Study abroad travel
Research position or internship
Non-research internship
Program expenses (summer, winter break, or spring break only)
Research materials or other project supplies (including memberships)
Conference expenses
Other
Please describe proposed activities and related expense(s) in greater detail. Explain how the expense(s) will be used.
*
e.g. This summer I will be doing research on voting registration laws with Prof. X of Political Science. I will use my funds for rent and other living expenses while I am in Rochester.
Your request MUST BE SIGNED by a Meliora Scholars mentor. WHO will you ask to sign your request?
First Name
Last Name
Mentor email: please type carefully!
example@example.com
**Please read carefully!** A copy of this form will be emailed your UR approver with a link to an approval form; please let your approver know that you have submitted a request for disbursement.
*
YES, I understand that it is my responsibility to let my approver know that I have requested funds from my Meliora Scholarship and to expect an email requesting their approval.
Submit
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