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APPLICATION COVER SHEET

GRANTS FOR INDEPENDENT RESEARCH
ON VENETIAN HISTORY AND CULTURE, 2009-2010

Name:
Mailing address:
Phone:
E-mail:
Use above address until:
Permanent address:
Permanent phone:
Highest degree:
Year conferred:
Project title:
Amount requested:	$
Proposed length and dates of Venetian stay:

Please check one: I am a United States ___ citizen. ___ permanent resident.

My social security number is _______-______-_______.

Ph.D. candidates only, please indicate when you fulfilled all doctoral requirements except completion of the dissertation (but including acceptance of dissertation proposal): _____________________.

Applications must be received by the Foundation no later than December 15, 2008.

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