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1. Name_________________________________________________________
( Last, First, Middle )
2. Mailing address_________________________________________________
Zip
Telephone_______________________________________________________
3. U. S. citizen? Yes ( ) No ( )
4. Date of Birth _______________ Place_______________________________
5. Social Security Number___________________________________________
6. Colleges and graduate schools attended, degrees and dates
conferred:
________________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
7. Academic honors received:__________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
8. Publications and major professional papers read:
________________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
9. Teaching, military, or other pertinent experience:_______________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
(Use separate sheets of paper to complete answers to 6, 7,
8, and 9, if necessary)
10. Dissertation title and date of acceptance:_______________________________
________________________________________________________________
11. Name, title, and address of dissertation director:_________________________
________________________________________________________________
________________________________________________________________
12. On separate sheets of paper explain your research plans and
significance of topic in sufficient detail for evaluation purposes.
13. Period for which grant is required:__________ to __________
(give month and year).
14. On a separate sheet of paper, set forth the proposed budget
for this grant. Please give separate figures for travel, living
expenses, document duplication, and other expenditures related
to the research and writing process.
15. Two persons who know you and your work, and who will be asked
by you to send letters of reference.
________________________________________________________________
Name, Address, Title
________________________________________________________________
Name, Address, Title
16. Do you foresee any circumstances--military service, family,
job offer, health, etc.--that might interfere with or interrupt
your tenure as a grant recipient?
Yes ( ) No ( )
(If answer is Yes, please explain on separate sheet of paper.)
___________________________________
Signature Date
Mail application and arrange for letters of reference to be sent as soon as possible, but so that they are received not later than March 31, 2009 to:
Naval History and Heritage Command
Senior Historian
805 Kidder Breese SE
Washington Navy Yard, DC 20374-5060
(Personal Data - Privacy Act of 1974)
NHHC Form 5751/4
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History & Heritage Command home page