2011 “Prevention of Epilepsy After Traumatic Brain Injury” Award
Letter of Intent (LOI)

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

Deadline for receipt: September 14, 2010. This is an interactive form. Please type directly into this form. Form accepts text only.

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:

Email:

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.