2012 “Prevention of Acquired Epilepsy” Award
Letter of Intent (LOI)

2- to 3-year award up to $250,000

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) Research Plan: ( characters) Must include: Hypothesis, Specific Aims, Description of the Research (include brief but succinct detail)

Estimated First Year of Budget: Estimated Total Budget:

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.