OMB Number 3136-0134 Exp: 7/31/18
You must accept or decline the offer of a 2016-2017 NEH fellowship no later than February 19, 2016. To accept the award, please complete, sign, and return the acceptance form to the NEH Fellowships Program by either scanning and e-mailing it to firstname.lastname@example.org or faxing it to (202) 606-8204 by this deadline.
1. Application Number: _____ _____ - _____ _____ _____ _____ _____ _____
2. Name: ________________________________________________________
3. Social Security Number: ____ ____ ____ - ____ ____ - ____ ____ ____ ____
4. Mailing Address: _________________________________________________________
Home Phone: ( ) ____ ____ ____ - ____ ____ ____ ____
Office Phone: ( ) ____ ____ ____ - ____ ____ ____ ____
5. Fellowship Tenure Period (Note: Tenure automatically begins on the first day of your initial
month and ends on the last day of your final month.)
From (Month/year): _______________ Through (Month/year): _______________
Number of months covered: ________________________
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: The 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.
8. Acceptance and Certification
I accept the offer of a fellowship and agree to comply with the conditions governing it as set forth in the General Information on NEH Fellowships. 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.
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 Director, 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.