LETTER OF INTENT- HD HUMAN BIOLOGY PROJECT Applicant Contact Information Question Title * 1. First Name Question Title * 2. Last Name Question Title * 3. Institution Name Question Title * 4. Researcher Title Question Title * 5. Department Question Title * 6. Address Address 1: * Address 2: City/Town: * State/Province: * ZIP/Postal Code: * Country: * Email Address: * Phone Number: * Mentor/Principal Investigator Contact Information Question Title * 7. First Name Question Title * 8. Last Name Question Title * 9. Institution Name Question Title * 10. Researcher Title Question Title * 11. Department Question Title * 12. Address Address 1: * Address 2: City/Town: * State/Province: * ZIP/Postal Code: * Country: * Email Address: * Phone Number: * Project Information Question Title * 13. Project Title Question Title * 14. Are you currently working at an HDSA Center of Excellence? Yes No Question Title * 15. If yes, provide details in box below. Question Title * 16. Are you currently collaborating with or have you identified a potential HDSA Center of Excellence for collaboration on this project? Yes No Question Title * 17. If yes, provide details in box below. Question Title * 18. Do you need assistance identifying a willing HDSA Center of Excellence Director as a collaborator? Yes No Question Title * 19. Will Institutional Review Board (IRB) or Institutional Animal Care and Use Committee (IACUC) approval(s) be needed before the proposed research can commence? Yes No Question Title * 20. If yes, please provide details to when approval can be expected. Project Proposal The project proposal is a Microsoft Word document of 1000 words or less. In the proposal, you must include the following information: 1. A short summary that outlines the intended research and specifically states how the results adhere to the Statement of Need listed in the Request for Proposal. 2. Background and/or Preliminary Data 3. Specific Aims 4. Experimental Plan, including time required to complete studies 5. Qualifications or the researcher/applicant Completed LOIs to be directed to George Yohrling (gyohrling@hdsa.org) Email George Yohrling Done