(please provide full name)
(DO NOT use Social Security Number; may be left blank for newly admitted students)
NEW Award Transmittal for FY'06 REVISION to a Previous Award Transmittal for FY'06
---Select Current Academic Program---Ph.D. Biochemistry & Molecular BiologyPh.D. Cell BiologyPh.D. Microbiology & ImmunologyPh.D. NeurosciencePh.D. PharmacologyPh.D. Physiology & BiophysicsPh.D. Tumor BiologyPh.D. Biomedical Sciences - UndifferentiatedPh.D. Biomedical Sciences - "Track" - Biochemistry & Molecular BiologyPh.D. Biomedical Sciences - "Track" - Cell BiologyPh.D. Biomedical Sciences - "Track" - Microbiology & ImmunologyPh.D. Biomedical Sciences - "Track" - PharmacologyPh.D. Biomedical Sciences - "Track" - Physiology & BiophysicsPh.D. Biomedical Sciences - GU/NIH - Biochemistry & Molecular BiologyPh.D. Biomedical Sciences - GU/NIH - Microbiology & ImmunologyPh.D. Biomedical Sciences - GU/NIH - PharmacologyPh.D. Biomedical Sciences - GU/NIH - Tumor BiologyPh.D. Biomedical Sciences - GU/NIH - UndifferentiatedM.D./Ph.D. - UndifferentiatedM.D./Ph.D. - Preclinical (M1)M.D./Ph.D. - Preclinical (M2)M.D./Ph.D. - Clinical (M3)M.D./Ph.D. - Clinical (M4)M.D./Ph.D. Biochemistry & Molecular BiologyM.D./Ph.D. Cell BiologyM.D./Ph.D. Microbiology & ImmunologyM.D./Ph.D. NeuroscienceM.D./Ph.D. PharmacologyM.D./Ph.D. Philosophy/BioethicsM.D./Ph.D. Physiology & BiophysicsM.D./Ph.D. Tumor BiologyM.D. Five-Year Research Track
(For students in thesis research, please provide the full name of their thesis mentor)
NOTE: The figures provided for reference on this form are based on projected Academic Year 2005-2006 fees and expenses; should any applicable fees or expenses increase for Academic Year 2005-2006, it is understood that the award amount will be automatically adjusted accordingly. If any total amount is divided between more than one cost center, please indicate the appropriate distribution for each account. If the total amount is divided between more than two cost centers, please use the Notations section at the bottom of this form to designate any additional distribution.
FOR ALL STIPEND AWARDS (new awards, renewals, and revisions): Please complete the appropriate stipend paperwork, as outlined in the Biomedical Graduate (GDM) Financial Award Processing Guidelines. Completion of the section below alone will not initiate stipend payments.
Stipend amounts are subject to proration for new students based upon actual start date.
FY'06 Stipend Award
Stipend Start Date MonthJanFebMarAprMayJunJulAugSepOctNovDec Day01020304050607080910111213141516171819202122232425262728293031, Year20052006 Stipend End Date MonthJanFebMarAprMayJunJulAugSepOctNovDec Day01020304050607080910111213141516171819202122232425262728293031, Year20052006 Debit Amount #1 Debit GU Cost Center #1 Debit Amount #2 Debit GU Cost Center #2
Stipend Start Date MonthJanFebMarAprMayJunJulAugSepOctNovDec Day01020304050607080910111213141516171819202122232425262728293031, Year20052006
Stipend Start Date
MonthJanFebMarAprMayJunJulAugSepOctNovDec Day01020304050607080910111213141516171819202122232425262728293031, Year20052006
Stipend End Date MonthJanFebMarAprMayJunJulAugSepOctNovDec Day01020304050607080910111213141516171819202122232425262728293031, Year20052006
Stipend End Date
Debit Amount #1
Debit GU Cost Center #1
Debit Amount #2
Debit GU Cost Center #2
Graduate Pre-Thesis $1,227.00 (per credit) $14,724.00 (per semester, 12+ credit full-time) $29,448.00 (per year, 12+ credit full-time) Graduate Thesis $2,500.00 (per semester) $5,000.00 (per year) Fall Semester 2005 (05C) Graduate Pre-Thesis Graduate Thesis Medical School Debit Amount #1 Debit GU Cost Center #1 Debit Amount #2 Debit GU Cost Center #2 Spring Semester 2006 (06A). Graduate Pre-Thesis Graduate Thesis Medical School Debit Amount #1 Debit GU Cost Center #1 Debit Amount #2 Debit GU Cost Center #2
Graduate Pre-Thesis
Graduate Thesis
Graduate Pre-Thesis Graduate Thesis Medical School
Debit Amount #1 Debit GU Cost Center #1 Debit Amount #2 Debit GU Cost Center #2
Debit Amount #1 Debit GU Cost Center #1
Debit Amount #2 Debit GU Cost Center #2
Graduate Pre-Thesis Graduate Thesis Medical School Debit Amount #1 Debit GU Cost Center #1 Debit Amount #2 Debit GU Cost Center #2
Yearly Health Insurance $2,500.00 Debit Amount #1 Debit GU Cost Center #1 Debit Amount #2 Debit GU Cost Center #2 Summer Health Insurance $550.00 (charged ONLY to new students who will commence their studies with a summer laboratory research rotation) Debit Amount #1 Debit GU Cost Center #1 Debit Amount #2 Debit GU Cost Center #2
Yearly Health Insurance
Summer Health Insurance
(charged ONLY to new students who will commence their studies with a summer laboratory research rotation)
Fall Semester 2005 (05C) Debit Amount #1 Debit GU Cost Center #1 Debit Amount #2 Debit GU Cost Center #2 Spring Semester 2006 (06A) Debit Amount #1 Debit GU Cost Center #1 Debit Amount #2 Debit GU Cost Center #2
(one-time fee charged to all students)
By my electronic signature, as provided below in the "Prepared by" box, I confirm that I am authorized to approve disbursements from the above noted Georgetown University account(s), and hereby request payment of the above noted financial award(s) from the Georgetown University account(s) indicated to the biomedical graduate student named. I also accept responsibility for the monitoring of award postings as provided to me via Cost Center Status Reports (CSRs), and agree to process any needed adjustments in a timely fashion.
(type full name)
