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
Please describe proposed activities and related expense(s) in greater detail. Explain how the expense(s) will be used.
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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?
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
A copy of this form will be emailed to you upon submission. Please VERIFY HERE that you understand that your submission is NOT COMPLETE until we receive an email (at undergradresearch@ur.rochester.edu) from your mentor indicating their understanding and approval of the proposed expense(s).
*
YES, I understand my next steps.
Submit
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