College of Liberal Arts Application for Funding for Brain Imaging Infrastructure Deadline: Friday, May 15, 2015 Application for CLA Research Supplements for Brain Imaging Infrastructure (e.g., equipment, supplies, computer hardware and software, etc.). Applications must include the signature of your unit chair/director. Applications are due in the Office of Research and Graduate Programs, 113 Johnston Hall or by email to fried053@umn.edu by noon, May 15, 2015 Name: Rank: Department: Email: Campus Address: Please indicate if this is a joint proposal and if so, with whom? Brief proposal: Include a proposal up to two pages and list any additional faculty or graduate students who are involved. Proposal Budget: Include itemized budget for all items up to $10,000. Please indicate any set-up, retention, grant funding or other funding that you propose to contribute to the overall cost of the project. (Cost share is not required, but should be considered if appropriate). Total dollar amount requested? EFS string for fund transfer? 1 ___________________________________ Applicant Signature ____________________ Date ___________________________________ Chair’s/Director’s Endorsement ____________________ Date ___________________________________ Funding Approved by ____________________ Date Submit application form: Office of Research and Graduate Programs College of Liberal Arts 113 Johnston Hall; Delivery Code 3774 2