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Grant Management

NEH-NSF Documenting Endangered Languages Fellowships Acceptance Form

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

You must accept or decline the offer of a 2014-2015 NEH-NSF Documenting Endangered Languages Fellowships award no later than Friday, May 16, 2014. 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 fellowships@neh.govor 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: ( ) ____ ____ ____ - ____ ____ ____ ____

E-mail: _________________________________________________________________

5. Award Term Period.  Please complete either a. or b. below:

a.  [ ] Continuous Term (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): _______________

 

b. [ ] Divided Term (indicate month/year in each space):

From ______________ through ______________ [ } Active full-time

From ______________ through ______________  [ ] Inactive

From ______________ through ______________ [ ]  Active full-time

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

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

[ ] Direct deposit payments into the account of your employing institution through Automated

Clearing House (ACH).

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

8. Do you need a larger first payment?     [ ]  No    [ ]   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.

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 2014-2015 NEH-NSF Documenting Endangered Languages 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.

 

_________________________________ ______________________________

Signature                                                          Date

Privacy Act Statement:   Social Security Numbers are required by law for the processing of payments of Federal funds.  Failure to provide this information may delay or prevent the receipt of payments through the Automated Clearing House Payment System.

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.