Student Project Form

Please complete ALL fields. The information that you submit will be sent to Larissa Mottl, CERA Manager.

Your Name: *

Your E-mail: *

Course Title: *

Instructor: *

Project Title: *

Project Description: *

Proposed project dates

Start date: *

End date: *

Is lab space required?: *

Yes

List equipment/supplies needed:

Use the map below to indicate your proposed field site location(s); multiple selections may be made using CTRL key (PC) or Command key (Mac): *

Explain your field site (if necessary), or use this space for questions you have for the CERA Manager.:

By submitting this form, you accept the Mollom privacy policy.

Application

Contact person:

Larissa Mottl

Contact information:

mottll@grinnell.edu

641-269-4717