subject_line
Letter of Intent (LOI) to submit a CFAR International Research Proposal
Date:
*
+
Applicant/Principal Investigator:
First Name:
*
Last Name:
*
Degree
Country:
*
Email address
*
International Institution
*
Department
*
Academic Appointment
*
Assistant Professor
Associate Professor
Professor
Other
Other
Application Type
*
New
Resubmission
Type of proposal
*
🛈
Initial HIV/AIDS
Pilot
Name of CFAR Mentor:
*
CFAR Mentor E-mail:
*
CFAR Mentor's Academic Appointment:
*
Assistant Professor
Associate Professor
Professor
Other
Other
CFAR Mentor's Institution:
*
Name of in-country contact:
*
🛈
Proposed Project
Project Title
*
Upload the project abstract (250 word limit)
*
Study Team
Please list all other proposed mentors and collaborators indicating their institution, role and area of expertise
Mentor/Collaborator
Institution
Role on Project
Area of Expertise
1
Mentor/Collaborator
Institution
Role on Project
Area of Expertise
2
Mentor/Collaborator
Institution
Role on Project
Area of Expertise
3
Mentor/Collaborator
Institution
Role on Project
Area of Expertise
4
Mentor/Collaborator
Institution
Role on Project
Area of Expertise
5
Mentor/Collaborator
Institution
Role on Project
Area of Expertise
6
Mentor/Collaborator
Institution
Role on Project
Area of Expertise
7
Mentor/Collaborator
Institution
Role on Project
Area of Expertise
Endorsements
Please confirm the following:
*
The in-country contact has reviewed and approves this LOI
The US based CFAR Mentor has reviewed and approves this LOI
The applicant attests that the proposed project is not funded from other sources
By signing, you as the applicant, agree that if accepted you will follow the guidelines in submitting a full proposal for consideration. (Sign this form using the mouse).
*
clear