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APPLICATION

JOHN JONES SCHOLAR IN WORKERS’ COMPENSATION RESEARCH

Name:

Tel.#   

Address:
             

Email address:

Date:              

Please attach a resume to this application.

Business /Organization/ University affiliation:

Title:

Attach a narrative of up to 2 pages describing the following points.

1.             Proposed use for the award funds.

2.             Significance of the proposed project.

3.             Data to be used.

4.             Timeframes for length of project.

5.             Plans to spend time at WCRI conducting research.

6.             Willingness to publish your results as a WCRI report.

Please print this completed application form and send along with narrative and resume to:

Linda Carrubba
Workers Compensation Research Institute
955 Massachusetts Avenue
Cambridge, MA 02139

Fax to her at 617-661-9284.

Or send via email: lcarrubba@wcrinet.org

Workers Compensation Research Institute, 955 Massachusetts Avenue
Cambridge , MA 02139
(617-661-9274) www.wcrinet.org

 

955 Massachusetts Avenue    Cambridge, Massachusetts 02139    617-661-WCRI (9274)

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