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Grant Management

NEH Awards for Faculty Acceptance Form

OMB No. 3136-0134 Exp: 7/31/15

You must accept or decline the offer of a 2015-2016 NEH Award for Faculty no later than February 20, 2015.  To accept the award, please complete, sign, and return the acceptance form to the NEH Awards for Faculty Program by either scanning and e-mailing it to facultyawards@neh.gov or faxing it to (202) 606-8204 by this deadline.

1.    Application Number:     HB-_______________________________________________

                                                            

2.    Name:   ______________________________________________________________

3.   Social Security Number:   _____ _____ _____ - _____ _____ - _____ _____ _____  _____

4.    Mailing Address:   ___________________________________________________________

                                       ___________________________________________________________

                                       ___________________________________________________________

       Home Phone: (          ) ______ - ______ - ______                               

       Office Phone: (          ) ______ - ______ - ______                               

       E-mail: ________________________________________

5.    Award for Faculty Tenure Period   (Note: Tenure automatically begins on the first day of your initial month and ends on the last day of your final month.)   Indicate the amount of time you’ll be working on your NEH project for each block of time.

From ___________ through ___________     o full-time   o half-time    o other___________    

From ___________ through ___________     o full-time   o half-time   o other___________                    

From ___________ through ___________     o full-time   o half-time    o other___________  

From ___________ through ___________     o full-time   o half-time    o other___________  

From ___________ through ___________     o full-time   o half-time    o other___________     

From ___________ through ___________     o full-time   o half-time    o other___________    

From ___________ through ___________     o full-time    o half-time   o other___________

6.    How would you like the stipend paid?  Choose only one option.

o    Direct deposit payments into your bank account through Automated Clearing House (ACH).

o    Direct deposit payments into the account of your employing institution through Automated Clearing House (ACH).

7.    Do you need your first payment early?                o   No                        o   Yes

8.    Do you need a larger first payment?                    o   No                        o   Yes

       Additional amount requested:   ___________________________                               

       Reason for a larger first payment: __________________________________________________ 

IMPORTANT: This acceptance form does NOT request banking information for direct deposit of your award payments.  Once your completed and signed acceptance form is received by NEH, you will be sent an award letter that includes instructions for submitting your banking information to NEH.

9.    Acceptance and Certification

I accept the offer of an award and agree to comply with the conditions governing it as set forth in the General Information on NEH Awards for Faculty.  I certify that the information submitted in this form is true and correct to the best of my knowledge and that any changes or additions will be promptly reported to NEH.

       __________________________________________                   ______________________________                                                                                                                    

                                    Signature                                                                                    Date

                                                                                                                                                             

Paperwork Burden:  NEH estimates the average time to complete this form is one hour per response.  This estimate includes the time for reviewing the instructions for this form, gathering the necessary data, and entering the data on the form.  Please send any comments regarding this estimated completion time or any other aspect of the form, including suggestions for reducing completion time, to the Chief Guidelines Officer, at Guidelines@neh.gov,  Office of Publications and Public Affairs, National Endowment for the Humanities, Washington, D.C. 20506; and to the Office of Management and Budget, Paperwork Reduction Project (3136-0134), Washington, D.C. 20503.  According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless it displays a valid OMB control number.