UNIVERSITY OF CALIFORNIA, IRVINE BERKELEY DAVIS IRVINE LOS ANGELES MERCED RIVERSIDE SAN DIEGO SAN FRANCISCO SANTA BARBARA SANTA CRUZ NEUROSCIENCE IMAGING CENTER Steven L. Small, Ph.D., M.D., Director David B. Keator, Ph.D., Operations Director Keith R. Burnett, M.D., Clinical Director Ahmed (Duke) Shereen, Ph.D., Lead Physicist Irvine Hall Room 181 Irvine, CA 92697-3960 Telephone: +1 (949) 824-7872 Email: small@uci.edu UNFUNDED MRI DEVELOPMENT PROPOSAL 1) Title of project: 2) Principal Investigator(s): a) Name: b) Department: c) Contact Information: 3) Description (NIH style: Specific Aims, Significance/Innovation, and Methods 2 pages max): 4) How does this MRI development project benefit the larger UCI imaging community (include specific faculty, technological improvement, what scientific questions can be answered with the success of this project that couldn't be answered before)? 5) Data collection requirements* a) Operator certification (date of last safety exam): b) Subject population (include medical conditions): c) Number of Subjects/Phantoms: d) Estimated Total Scanner Time: e) Special data acquisition, storage, or processing requirements: 6) Plans for acquiring extramural funding (time table for submission after completion of pilot data): 7) Projected utilization of NIC by grant if funded: 8) IRB approval letter (if applicable, i.e. scanning humans participants)** 9) IRB consent form (if applicable) *Proposals requesting >15 hours of scanner time may not be approved unless a compelling reason is given. Note, at time of scheduling unfunded scan, slots may not be booked more than 1 week in advance to give priority to funded projects unless scan occurs outside regular business hours. **If animals are to be used for any portion of the development project, please include the appropriate IACUC approval information. Version 3/21/16