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Grant Management

NEH Summer Stipends Acceptance Form

OMB No. 3136-0144 Exp: 7/31/18

You must accept or decline the offer of a 2017 Summer Stipend award no later than April 28, 2017.  To accept the award, please complete, sign, and return this acceptance form to the NEH Summer Stipends Program by scanning and e-mailing it to stipends[at]neh[dot]gov by the deadline.

1.    Application Number:   FT - _____ _____ _____ _____ _____

2.   Name:  __________________________________________________________________

3.    Social Security Number:   ____   ____   ____   –   ____   ____   –   ____   ____   ____   ____

4.    Mailing Address: _____________________________________________________________



       Home Phone: (           )  ____  ____  ____ -  ____  ____  ____  ____                           

       Office Phone: (           )  ____  ____  ____ -  ____  ____  ____  ____                           

       E-mail: ______________________________________________________________________

5.    Summer Stipend Tenure Period:                                                                                

       From ______________________________ through __________________________________                                                      

                                Month/year                                                      Month/year

Note: Tenure must be for two continuous months of full-time commitment to research and writing. It automatically begins on the first day of your initial month and ends on the last day of your final month.

6.    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 Summer Stipends Awards.  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 the 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.