Sustainable History Monograph Pilot: Subvention Request

Sustainable History Monograph Pilot Subvention Request

Date: *

Press Name: *

Project Author: *

Project Title: *

Requestor Information

Requestor Name: *

First

Last

Requestor Phone *

Requestor Email: *

Matching Request Information

Author's Home Institution (AHI): *

List the individuals or departments at the AHI where requests were sent: *

Amount provided: *

If not $5,500, please provide rationale that we can include in our public reporting below:

Details on other subvention requests:

SUMMARY

Total Subvention amounts received: *

Amount requested from Mellon ($7,000 minus Total Subvention amounts received per above): *

Check made out to: *

Deliver to the attention of: *

Address *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

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Phone

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