LOI – DRAFT - MMJ Outcomes

Principal Investigator (PI) Information

Please fill in the contact information for the principal investigator (PI) of the proposed research. Note: PI must be a faculty member at a Consortium member institution.

First Name *

Last Name *

Suffix

Phone Number *

Email Address *

NIH Style Biosketch of PI (max. 5 pages) *

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Institution and Research Team Information

Please fill in the information for the institution and the research team of the proposed research.

Please list key research team members/collaborators (tentative) and their institutional affiliations.

Full Name and Institutional Affiliation of Key Research Team Members/Collaborators (tentative) *

Proposed Research Information

Please fill in the information for the tentative title, aims, and methods of the proposed research.

Title of Proposed Research (tentative) *

Please select the funding level you will be applying for (you may apply to only one): *Level 1 ($75,000 for 1 year)Level 2 ($130,000 for 2 years*)*contingent upon state funding and review of progress

Was this proposal submitted in a previous grants cycle? *YesNo

What year was this proposal submitted? *

Aims of Proposed Research (max. 250 words) *0 / 250

Methods of Proposed Research (max. 250 words) *0 / 250

Clinical Relevance of Proposed Research (max. 250 words) *0 / 250

Potential Applicant Reviewers

Please propose three reviewers (with primary appointment at institutions outside of Florida, within the US, and otherwise no conflict of interests) and provide their names and email. Potential reviewers should have extramural research funding and/or published work in the related topic area.

Potential Reviewer Full Name *

Institution *

Email Address *

Potential Reviewer Full Name *

Institution *

Email Address *

Potential Reviewer Full Name *

Institution *

Email Address *

PI Certification

By entering your full name below, you as the PI certify that all the information listed above is correct and acknowledge that you have not submitted another proposal.

Full Name *

Date *

Letter of Intent (LOI) Submission Form

Principal Investigator (PI) Information

Please fill in the contact information for the principal investigator (PI) of the proposed research. Note: PI must be a faculty member at a Consortium member institution.

Institution and Research Team Information

Please fill in the information for the institution and the research team of the proposed research.

Please list key research team members/collaborators (tentative) and their institutional affiliations.

Proposed Research Information

Please fill in the information for the tentative title, aims, and methods of the proposed research.

Potential Applicant Reviewers

Please propose three reviewers (with primary appointment at institutions outside of Florida, within the US, and otherwise no conflict of interests) and provide their names and email. Potential reviewers should have extramural research funding and/or published work in the related topic area.

PI Certification

By entering your full name below, you as the PI certify that all the information listed above is correct and acknowledge that you have not submitted another proposal.