HHMI Translational Research and Public Health Application

Name * First Last
Email *
Department *
Type of Funds Requested *
Start Date * / MM / DD YYYY
End Date * / MM / DD YYYY
Student #1 First Last
Student #1 Email
Student #1 Class Year
Student #2 Name First Last
Student #2 Email
Student #2 Class Year
Project Title *
Does the research anticipate the use of human beings as experimental subjects? * Yes No
If "Yes",the status of the proposal to Committee on Grants (as an IRB) Received Pending Approved
Does the research anticipate the use of vertebrate as experimental subjects? * Yes No
If "Yes",the status of the proposal to the Institutional Animal Care and Use Committee (IACUC)? Received Pending Approved
Project Summary and Specific Aims (100 words or less) *
Project Description (500 words or less) *
Number of Stipends (max. 2)
Supplies Amount Requested (max. $3,000) $ . Dollars Cents
Translational Research Summer Scholars only
Budget Justification *