INDO-U.S. VACCINE ACTION PROGRAM (VAP) INITIATIVE ON TUBERCULOSIS (TB) RESEARCH:
REGIONAL PROSPECTIVE OBSERVATIONAL RESEARCH FOR TUBERCULOSIS
Letter of Intent (LOI) Template
DEADLINE FOR SUBMISSION: FRIDAY, JUNE 15, 2012, 5:00 PM US EASTERN DAYLIGHT TIME (EDT)
E-MAIL: TBCOHORT@CRDFGLOBAL.ORG
GENERAL PROJECT INFORMATION
Application Type (please select ONE):
dCRU
fCRU
Application Title:
INDIAN PRINCIPAL INVESTIGATOR INFORMATION
Last Name:
First:
Middle:
Current Position at your Institute:
Institute Name:
Street Address:
Apartment/Unit/Office #:
City:
State:
Phone:
E-mail Address:
Highest Degree Earned:
Postal Code:
Field of Degree:
Year Awarded:
U.S. PRINCIPAL INVESTIGATOR INFORMATION
Last Name:
First:
Middle:
Current Position at your Institute:
Institute Name:
Street Address:
Apartment/Unit/Office #:
City:
State:
Phone:
E-mail Address:
Highest Degree Earned:
Postal Code:
Field of Degree:
Year Awarded:
ADDITIONAL PERSONNEL
Please list information for other key personnel on the Indian and U.S. research teams (Please copy the table for additional team members)
Team Member 1:
Indian Participant
U.S. Participant
Full Name:
Current Position:
Institute:
E-mail Address:
Highest Degree Awarded:
Field of Degree:
Year Awarded:
Description of Participant’s Role on Project (2-3 sentences):
1
INDO-U.S. VACCINE ACTION PROGRAM (VAP) INITIATIVE ON TUBERCULOSIS (TB) RESEARCH:
REGIONAL PROSPECTIVE OBSERVATIONAL RESEARCH FOR TUBERCULOSIS
Team Member 2:
Indian Participant
U.S. Participant
Full Name:
Current Position:
Institute:
E-mail Address:
Highest Degree Awarded:
Field of Degree:
Description of Participant’s Role on Project (2-3 sentences):
Year Awarded:
Narrative:
Instructions: In the spaces below, please provide thorough but brief responses to each component of the LOI
narrative. Your narrative responses may not exceed four (4) pages total (not including team member/project
information requested above) and must be completely contained inside the text boxes. All answers must be
typed, in English, single-spaced, with one-inch margins on all side and no less than Arial 10pt font.
1.
Summary Statement: In one concise paragraph, summarize all relevant aspects of the project, with special attention to its
objectives, methods, and potential results.
2.
Background/Rationale: This should include a problem statement and a brief description of the current conditions in your area
3.
Primary Objectives for both clinical and fundamental research aspects of the proposal: (including how these objectives relate
to the objectives of the Program)
2
INDO-U.S. VACCINE ACTION PROGRAM (VAP) INITIATIVE ON TUBERCULOSIS (TB) RESEARCH:
REGIONAL PROSPECTIVE OBSERVATIONAL RESEARCH FOR TUBERCULOSIS
4.
Description of the proposed research site:
5.
Description of the Cohort:
6.
Brief research study design: (including the proposed collaboration and how the combined competences of each research team
will contribute to the overall project plan)
7.
Overall Budget Estimate: (*Note: For the purposes of the LOI, the budget estimate should be 2-3 lines only. At this time,
applicants are not required to submit a detailed budget)
We hereby certify that all information contained in this document is accurate to the best of our knowledge. We understand that
knowingly submitting misrepresented or falsified information may be grounds for rejection of our application and could
jeopardize our eligibility to this and future CRDF Global, NIH, and DBT programs.
Indian Principal Investigator Signature: _________________________________
Date:
U.S. Principal Investigator Signature: __________________________________
Date:
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INDO-U.S. VACCINE ACTION PROGRAM (VAP) INITIATIVE ON TUBERCULOSIS (TB) RESEARCH:
REGIONAL PROSPECTIVE OBSERVATIONAL RESEARCH FOR TUBERCULOSIS