2012 Challenge Award
Letter of Intent (LOI)

2- to 3-year award up to $250,000 (for a maximum of $250,000 total)

Deadline for receipt: December 13, 2011. This is an interactive form. Please type directly into this form. Form accepts text only. If you have previously started the application and wish to continue where you left off, please enter your Email address and hit the "Load" button.

Email:       Project Title: Name:    first    middle    last Degree(s): Academic Position: Institutional Affiliation: Department: Address 1: Address 2: Address 3: City: State: - AB AK AL AR AZ BC CA CO CT DC DE FL GA HI IA ID IL IN KS KY LA MA MB MD ME MI MN MO MS MT NB NC ND NE NF NH NJ NM NS NT NV NY OH OK ON OR PA PE QC RI SC SD SK TN TX UT VA VT WA WI WV WY YT Zip: Country: Telephone: Fax:

Keywords (enter 5-8):         Summary of Project: ( characters) How will this research meet CURE’s mission (no seizures/no side effects), and specifically one of the following priority areas: (1) the basic mechanisms of epileptogenesis; (2) the multifaceted causes of epilepsy; (3) the pediatric epilepsy syndromes; (4) new animal models of epilepsy: ( characters) Research Plan: ( characters) Must include: Hypothesis and Specific Aims,description of the research (include brief but succinct detail)

Estimated First Year Budget: Estimated Total Budget : Duration of Study : (in years)

Additional Research Support: list funding source, amount of funding, and date of all received, requested, and anticipated funding:

Source: Amount: Date: Source: Amount: Date: Source: Amount: Date: Source: Amount: Date: Source: Amount: Date: Source: Amount: Date: Source: Amount: Date:

Additional Comments:

Have you ever applied for a grant from CURE? Y N Have you ever received a grant from CURE? Y N

How did you hear about CURE:

Do not include materials other than those requested. Additional materials will not be considered in the LOI review process. All materials must be submitted in English.