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• ����ֱ�� Student Identification Number
• Student's Full Legal Name (for pay purposes)
• Optional: Student's Preferred Name
• Student's Phone
• Student's Email
• Academic Major(s) or "Undecided"
• Expected Graduation (Month & Year)
• Do you plan to graduate from your undergraduate program next fall (December)?
• Are you an international student/non-resident?
• Have you ever been employed by the University of ����ֱ�� Boulder and been given an "employee identification number" (EID)?
• If applicable: Student's Employee Identification Number (EID)

You will not be able to change any of the following form fields, which are based on your award offer. ��If you applied for more than one grant, pay attention to the term of your offer.

• Read Only: Awarded Grant Term
• Read Only: Awarded Grant Type
• Read Only: Award Amount
• Read Only: Department Transfer Amount
• Read Only: Project Title

• Mentor's Full Name
• Mentor's Title/Faculty Rank
• Mentor's Department or Program
• Mentor's Email
• Will an additional supervisor help mentor this project?

• If applicable: Additional Supervisor's Full Name
• If applicable: Additional Supervisor's Title/Faculty Rank
• If applicable: Additional Supervisor's Department or Program
• If applicable: Additional Supervisor's Email

Failure to satisfy these terms and conditions could affect your eligibility to receive part or all of your UROP funding. ��Please communicate with us about any change in status.

• Maintain status as a degree-seeking undergraduate throughout the grant term.
• Complete the proposed project to the best of your ability.
• Maintain communication with your mentor.
• Complete all applicable university compliance procedures.
• Respond to UROP communications in a timely manner.

Payments to recipients who are U.S. citizens are not typically subject to federal and state income tax withholding and payroll taxes (i.e., FICA and Medicare taxes). The university has no tax reporting requirement for these payments (no W-2), but��is required to report payments on the federal form 1042-S.��Students should know that payments may be taxable income and should consult with their tax advisors. Non-residents are subject to federal income tax withholding��and��should schedule an appointment with an��.

If you do not have a social security number (SSN), you might need to apply for one to receive payment from UROP (or arrange an alternative form of payment).�� If you are a non-resident, undocumented and/or DACA student, we will work with you to find the best payment option for your circumstances. Contact us for instructions and documentation—and let us know as you have questions.

If a student is injured in the performance of activities related to their project during the term of their award, they might be eligible to receive Workers’ Compensation because UROP stipends can meet the conditions of “paid internships” as described in the university’s workers’ compensation policy.

UROP funding is not dependent on the submission of a report or survey, but we appreciate��and are��aided by your thoughtful feedback.�� Links to surveys and instructions for completion will be emailed��during the grant term.

You will be required to agree to the following liability waiver:

I exercise my own free and voluntary choice to participate in the designated activity. I understand and assume all associated risks of the designated activity.

Despite careful and proper preparation, instruction, medical advice, conditioning and equipment, there is still a risk of serious injury when participating in any activity/program. Understandably, not all hazards and dangers can be foreseen.

Participants in a ����ֱ�� sponsored program must understand that depending upon the particular activity may include but not limited to: dangers and injuries due to natural occurrences beyond human control or influence, exposures to community spread illnesses or diseases, trips, falls, sprains, strains, contusions, lacerations, fractures, broken bones, paralysis, concussions, and all other circumstances inherent to these activities.

Use of a privately-owned vehicle, including the operation or as a passenger, may be an option while participating in the off-campus trip activity. The University of ����ֱ�� does not provide liability or physical damage insurance coverage on privately owned vehicles. The vehicle owner must provide the liability and physical damage insurance coverage for a privately owned vehicle.

The University of ����ֱ�� does not provide health insurance for individuals participating in activities made available or sponsored by the University of ����ֱ��. As such, you or your personal health insurance will be responsible for payment of medical services and care for any injuries sustained during the designated activity.

You will be asked to agree or decline the following publicity release:

I hereby give permission to the University of ����ֱ�� and its agents or employees, to use my name and major, my mentor's name and department/program, and related presentation, performance or exhibition information in any publication which may include printed or electronic media, or both.

I hereby relinquish any right to inspect or approve the completed product or products which may include advertising copy or any other printed or electronic matter that may be used in conjunction with them now or in the future, whether that use is known to me or unknown, and I waive any right to royalties or other compensation arising from or related to the use of the designated information.

I hereby agree to release, defend and hold harmless the University of ����ֱ�� and its agents or employees, including any firm publishing or distributing the finished product or products in whole or in part, whether on paper or via electronic media, from and against any claims, damages or liability arising from any misuse of the designated information, either intentionally or otherwise, that may occur or be produced in the production of the finished product, its publication or distribution.