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1. Principal Investigator's Name (Last, First) (Required.)

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2. Project/Study title (Required.)

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3. Funding Agency (Required.)

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4. If funded by the NIH, Institute and Grant number

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5. Local Collaborator

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6. Ending the Epidemic Pillar(s) (Required.)

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7. Study start Date

Date

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8. If completed, Study End Date

Date

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9. If applicable, Publications (List PMID)/Links to results

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10. If applicable, Presentations to external audiences

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11. If applicable, dissemination to community partners and/or stakeholders

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12. Please describe in Lay Language, in 2-3 sentences, why this study is important to the community

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13. If applicable, Please describe in Lay Language, in 2-3 sentences, the results of your study.

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