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2011 NIMH Outreach Partnership Program Solicitation

For the following states: Colorado, Connecticut, Florida, Georgia, Idaho, Kansas, Kentucky, Louisiana, Maine, Maryland, Massachusetts, Minnesota, Nebraska, Nevada, New Hampshire, New Jersey, New Mexico, New York and New York City, Ohio, South Carolina, Tennessee, Texas and Texas Border Area, Utah, Vermont, Virginia, and Wisconsin.

Prepared by Outreach Partnership Program, Office of Constituency Relations and Public Liaison, National Institute of Mental Health

June 9, 2011

Contents

Solicitation

Preparing the Proposal

NIMH Outreach Partnership Program Solicitation

The National Institute of Mental Health (NIMH) is soliciting proposals for its Outreach Partnership Program from organizations in 26 states, including: Colorado, Connecticut, Florida, Georgia, Idaho, Kansas, Kentucky, Louisiana, Maine, Maryland, Massachusetts, Minnesota, Nebraska, Nevada, New Hampshire, New Jersey, New Mexico, New York and New York City1, Ohio, South Carolina, Tennessee, Texas and Texas Border Area2 , Utah, Vermont, Virginia, and Wisconsin. Non-profit organizations that conduct outreach focused on mental health are invited to submit proposals. Organizations with experience in child and adolescent mental health, and/or mental health disparities are encouraged to apply.

_____________________________

1. New York City as defined by the New York State Office of Mental Health 

2. The Texas Border Area as defined by the Texas Department of State Health Services 

Funding under this solicitation is awarded for one (1) year and renewable for two (2) more years for organizations that meet all Program requirements, contingent upon continued funding for the Program. The Outreach Partnership Program supports 55 Outreach Partners: one (1) in each state, the District of Columbia, and Puerto Rico. The states of California, New York, and Texas each have two (2) Outreach Partners.

NIMH plans to make a total of 28 awards from 26 states as listed above. Outreach Partners selected in New York City and the Texas Border Area will conduct outreach activities only in their respective region. Each Outreach Partner operates independently of the NIMH and is selected through a competitive process in which applications are reviewed by experts internal and external to NIMH. A list of current Outreach Partners can be found on the NIMH website

Contact us for questions.

General Program Requirements

Outreach Partners are required to conduct statewide, science-based mental health outreach and education activities; implement a special outreach project(s) on a defined topic; and promote involvement in National Institutes of Health (NIH) and NIMH research. The specific requirements for participation in the Outreach Partnership Program are listed below and described in more detail in the Statement of Work section.

  1. Designate a person to manage the organization's participation in the Outreach Partnership Program. This person will serve as the primary contact with NIMH. Applicants must also identify a backup contact person.
  2. Attend the Outreach Partnership Program annual meeting and participate in other Program-related education and training activities such as teleconferences.
  3. Disseminate NIMH research findings and science-based educational materials statewide.
  4. Conduct a local or state special outreach project(s) addressing mental disorders among children and adolescents, and/ or mental health disparities that occur by race or ethnicity, age (e.g., older adults), education or income, disability status, geographic location, risk status related to sex and gender, and among other populations identified to be at-risk for health disparities such as immigrants, and military service members and their families.
  5. Promote, at the state and local levels, involvement in NIMH and NIH research.
  6. Submit online quarterly progress reports (due April 30, July 31, October 31, and January 31) and a brief end-of-year narrative progress report, including a summary of any changes to proposed activities anticipated in the subsequent year/s (January 31).

Failure to comply with these requirements may result in forfeiture of participation in the Program.

Organizational Eligibility

To be considered for an award, an organization must meet the following criteria:

  • Organization must be located and have a mailing address in the state for which they are applying.
  • Organizations that are tax exempt, with a non-profit status, under any section of the United States tax code.
  • Organizations that meet Federal Equal Employment Opportunity (EEO) requirements.
  • Organizations that have an active record in the Central Contractor Registration  (CCR) database, and have the capacity to renew the record annually.

Organizational Capabilities

To be considered for an award, an organization must demonstrate the following criteria:

  • Organizations that demonstrate stable infrastructure, staffing, and financial solvency.
  • Information Technology capabilities that include:

Benefits to Outreach Partners

The Outreach Partnership Program will provide the following benefits during the contract term (i.e., 12 months with the potential for two option years).

Funding
Outreach Partners receive an annual award of $7,500. NIMH recognizes that the award amount may not cover the entire costs of the required tasks, and encourages Partners to leverage it to secure and/or supplement other resources. All costs associated with performing the required tasks, and meeting the timeline and deliverables schedule shall be the responsibility of each Outreach Partner organization.

Education, Training and Networking
NIMH covers the costs for Outreach Partners to attend the Program's annual meeting. The annual meeting brings together researchers, Outreach Partners, National Partners, NIMH staff, and other key stakeholders. At this meeting, Outreach Partners learn about research advances in the causes, diagnosis, prevention, and treatment of mental disorders. Outreach Partners also benefit from networking with each other and learning about other Outreach and National Partners' resources and initiatives. NIMH also facilitates networking through a Partners-only website and listserv, and teleconferences.

Materials
Outreach Partners have dedicated access to NIMH publications and other materials at no cost. In addition, Outreach Partners receive, via electronic distribution, the biweekly Update, which summarizes the latest mental health research findings, recently released Federal grant opportunities, and new government resources. NIMH may provide adaptable outreach tools and materials to support outreach and education efforts that coincide, for instance, with special observances like National Children's Mental Health Awareness Day. Outreach Partners also are provided with an NIMH widget to highlight the organization's participation in the Outreach Partnership Program on their website.

Other Benefits
Outreach Partners have opportunities to provide NIMH with feedback on research priorities, which supports the development of the national mental health research agenda. Through dialogue at the annual Program meeting and other venues as well as the Program progress reports, these insights from Outreach Partners help the NIH/NIMH better understand and meet the needs of an increasingly diverse population. Outreach Partners also have opportunities for networking and collaborating with NIMH-funded researchers and other experts in the field. NIMH Outreach Partnership Program staff provide assistance in identifying local researchers if requested by Outreach Partners. To the extent possible, NIMH Outreach Partnership Program staff also assist Outreach Partners in gathering resources about research on various topics.

Background on NIMH

NIMH, one of 27 institutes at the NIH, is the lead Federal agency for research on mental disorders. NIH is part of the U.S. Department of Health and Human Services.

NIMH envisions a world in which mental illnesses are prevented and cured. The mission of NIMH is to transform the understanding and treatment of mental illnesses through basic and clinical research, paving the way for prevention, recovery, and cure. This public health mandate demands that the Institute harness powerful scientific tools to achieve better understanding, treatment, and eventually, prevention of these disabling conditions that affect millions of Americans. To fulfill its mission, the Institute:

  • Conducts research on mental disorders and the underlying basic science of the brain and behavior;
  • Supports research on these topics at research settings throughout the United States and the world;
  • Collects, analyzes and disseminates information on the causes, occurrence, and treatment of mental illnesses;
  • Supports the training of more than 1,000 scientists each year to carry out basic and clinical mental health research; and
  • Communicates with scientists, current and past users of mental health services, families, the news media, primary care and mental health professionals and others about mental illnesses, the brain, behavior, and opportunities and research advances in these areas.

The success of the Institute's mission depends on the effective collaboration of all stakeholders in the field of mental health. This requires strengthening current partnerships and working to build new ones so that the Institute understands the needs, capabilities, and limitations of the field as it works with its partners and other stakeholders to move the science forward. For additional information on the Institute and its mission, goals, and activities, please visit the NIMH website.

Description of the Outreach Partnership Program

The Outreach Partnership Program is a nationwide initiative of NIMH that enlists national, state, and local non-profit organizations with demonstrated experience in mental health outreach and education to increase the public's access to science-based mental health information and encourage involvement in NIH and NIMH research, which is of particular importance among populations that experience mental health disparities. Through its education and outreach and that of its Outreach Partners, NIMH strives to:

  • Foster more widespread understanding about mental disorders, the brain, and behavior, thereby helping to reduce myths and misperceptions that contribute to stigma and discrimination;
  • Help promote the acceptance and social inclusion of individuals affected by mental illness;
  • Increase awareness of the role of basic, translational, and clinical research in the understanding, prevention, and treatment of mental illnesses; and
  • Increase awareness about the opportunities to benefit from participation in mental health research.

Statement of Work – Required Tasks

Task 1: Managing the Project

Designate a person that is responsible for the management of the organization's participation in the Program, including accomplishing the tasks, ensuring that all education and outreach efforts are based on the most current science, and preparing contract deliverables. This person will serve as the primary point of contact with NIMH. Applicant organizations also must designate a backup contact person. The primary or backup contact must participate in all NIMH Outreach Partnership Program education and training activities

Outreach Partners should have a commitment to science-based education and serve as a resource in their state for outreach and education on mental health.

Each Outreach Partner organization must be able to work toward the goals of the Outreach Partnership Program, and must have adequate staff to accomplish the required tasks and to submit online progress reports. Applicant organizations must demonstrate experience and capacity to disseminate information statewide, conduct state or local outreach and education, and collect data and information about their outreach activities

NIMH requires Outreach Partners to monitor and report their activities quarterly through online progress reports, which collect data and information about Program-related activities such as:

  • Types of NIMH materials and information disseminated;
  • Number of attendees/individuals who received these materials;
  • Number of conferences, meetings, and community events where NIMH research and publications were distributed;
  • Number of listserv postings and number of people subscribed to the listserv;
  • Number of website and social networking site postings;
  • Number of articles in organization's online and print publications and number of subscribers; and
  • Number of media interviews conducted and stories placed.

NIMH is committed to helping Outreach Partners enhance their ability to provide mental health education and outreach and expects a reciprocal commitment from each Outreach Partner. Outreach Partners are expected to demonstrate this commitment by taking full advantage of the following opportunities:

  • Attend the Program’s annual meeting (all costs for one person to attend are covered by the Program);
  • Participate in the flow of information among Partners by regularly monitoring and contributing to discussions on the listserv established for Outreach Partners;
  • Utilize the NIMH and Outreach Partnership Program websites and educational materials provided by NIMH; and
  • Participate in Program teleconferences and other Program-related activities.

Task 2:  Disseminating NIMH Research Findings and Science-based Educational Materials

Widely disseminate NIMH research findings and educational materials to a variety of audiences throughout the state. NIMH expects Outreach Partners to distribute information through multiple channels such as:

  • Member/partner/affiliate listservs;
  • Traditional and online media;
  • Website and social networking sites (e.g., Facebook, YouTube);
  • Conferences and meetings;
  • Community events; and
  • Online and print newsletters/publications.

Outreach Partners will work to increase public awareness of the critical role of research in expanding the understanding, diagnosis, prevention, and treatment of mental illnesses to improve the lives of individuals and families affected by these disorders. Outreach Partners will disseminate information and documents provided by NIMH and post links on their website to the:

Outreach Partners will have access to the latest scientific findings, publications, and other educational materials from the Program.

Task 3:  Conducting Targeted Outreach (Special Project/s) on Mental Disorders among Children and Adolescents, and/or Mental Health Disparities

Conduct science-based education and outreach addressing:

  • Mental disorders among children and adolescents; and/or
  • Mental health disparities, including those that occur by race or ethnicity, age (e.g., older adults), education or income, disability status, geographic location, risk status related to sex and gender, and among other populations identified to be at-risk for health disparities such as immigrants, and military service members and their families.

This outreach (special project/s) may address specific topics such as suicide, traumatic stress and trauma-related mental disorders (such as those associated with history of interpersonal violence, manmade and natural disasters, or deployment and combat), the economy, perinatal depression, or other mental health issues.

Outreach Partners will disseminate NIMH science-based messages, materials, and current research findings to address these issues and adapt messages as needed to ensure cultural and linguistic relevance.

Applicants must identify their area of focus, target audience(s), and the specific science-based activities they will conduct to reach these audience(s) for the duration of the contract term (i.e., 12 months with the potential for two option years). Organizations should provide a rationale regarding the specific activities they plan to conduct. Examples of individuals and intermediaries that may be targeted as part of these efforts include, but are not limited to:

  • Parents and/or caregivers;
  • Mental health, primary care or other health providers;
  • Schools;
  • Professional and civic groups;
  • Faith-based communities;
  • Employers;
  • Community mental health centers;
  • Hospitals and community health clinics; and
  • Criminal justice and law enforcement.

Task 4: Advancing Research

Promote, at the state and/or local levels, volunteer participation in clinical research sponsored by NIMH and NIH, particularly among diverse racial and ethnic groups, and form collaborations with researchers to the extent feasible. Requirements include:

  • Provide links on the organization's website to the NIMH Clinical Trials web page (http://www.nimh.nih.gov/trials/index.shtml) and the NIH Clinical Trials web page (http://www.clinicaltrials.gov ).
  • Distribute NIMH and NIH materials on participation in clinical research, such as NIMH's brochure, A Participant's Guide to Mental Health Clinical Research (http://www.nimh.nih.gov/health/publications/a-participants-guide-to-mental-health-clinical-research/index.shtml) and/or NIH information on understanding clinical trials (http://www.clinicaltrials.gov/ct2/info/understand ), as appropriate.
  • Inform constituents about clinical research recruiting participants, particularly among diverse racial and ethnic groups. (Work with universities and researchers to determine appropriate studies.) For information about NIH and NIMH-funded studies currently recruiting participants, visit: http://www.clinicaltrials.gov .
  • Act as a resource for universities and research institutions in the state in determining priorities for conducting mental health research.
  • Collaborate with researcher(s) to enhance local outreach and education, and clinical research promotion and participation. This researcher(s) should be a psychiatrist, psychologist, neuroscientist/neurobiologist, doctoral level social worker, or public health professional actively engaged in research related to mental health and affiliated with a university, teaching hospital, or research center. Note: Applicants do not need an established relationship in place at this time, but need to demonstrate the commitment to doing so. NIMH grantees are preferred, but not required. NIMH can assist Outreach Partners in identifying grantee(s) in their state or community.

A clinical trial (also known as clinical studies or clinical research) is generally considered to be biomedical or health-related research study in human beings that follow a pre-defined protocol to answer specific health questions. Carefully conducted clinical trials are the fastest and safest way to find treatments that work in people and ways to improve health. For more information, go to ClinicalTrials.gov .

Reporting Requirements and Deliverables

In addition to completing the tasks above, Outreach Partners must complete and deliver the following:

  • Online quarterly progress reports on or before the due date (April 30, July 31, October 31, and January 31) and a brief end-of-year narrative progress report, including a summary of any changes to the proposed activities (January 31). 
  • Invoices (once yearly following completion of the end-of-year progress report).  Note: Initial award will be paid at the start of the project and after submission of the end-of-year progress report in subsequent years.

Failure to comply with these requirements may result in forfeiture of participation in the Program.

Proposal Review and Evaluation Criteria

Applicant proposals will be reviewed by a panel of experts in the field. Reviewers will score each proposal based on the evaluation criteria outlined below and will make recommendations to NIMH. Final selection of Outreach Partners will be made by NIMH.

Task 1: Managing the Project (20 points)
 Review will be based upon demonstrated experience and ability to manage the project, appropriate staffing, and experience and capability to disseminate science-based information statewide and monitor and report data related to outreach and education activities.

Task 2: Disseminating NIMH Research Findings and Science-based Educational Materials (30 points)
Review will be based upon demonstrated experience, adequacy and creativity of the plan for statewide dissemination of NIMH research findings and educational materials, the breadth of audiences that may be reached, and channels utilized to reach these audiences.

Task 3: Conducting Targeted Outreach (Special Project/s) on Child and Adolescent Mental Health and/or Mental Health Disparities (20 points)
Review will be based upon demonstrated experience, adequacy and creativity of plan, rationale for focus of activities, and ability to form relationships with community and civic groups.

Task 4: Advancing Research (20 points)
Review will be based upon demonstrated experience in promoting research involvement, adequacy and creativity of plan, and, if feasable, ability to form relationships with the research community.

Organizational Capabilities (10 points)
Review will be based upon demonstrated stable infrastructure, staffing, and financial solvency, and information technology infrastructure.

Organizational Eligibility
Proposals from organizations not providing evidence of eligibility will not be reviewed.

Total Points: 100

Preparing the Proposal

Timeline

  • June 9, 2011, 10:00 AM (ET): Solicitation posted
  • June 30, 2011: Deadline for inquiries
  • July 21, 2011: Response to inquiries posted
  • August 23, 2011, 4:00 PM (ET): Proposals due
  • End of 2011: Outreach Partner selection
  • January 2012: Awards announced

Proposal Contents

  1. Cover letter signed by an officer of the Applicant’s organization with the authority to commit the organization to the proposal content.
  2. Table of contents
  3. Proposal for completing the required items (See Detailed Instructions pages 11-14)
    Task 1 2-4 pages + resumes
    Task 2 2-3 pages
    Task 3 2-3 pages
    Task 4 2-3 pages
    Organizational Capabilities 1-2 pages
    Organizational Eligibility documentation requested
  4. Completed Outreach Partnership Program Organization and Contacts Form included as an Appendix.

Applicants are strongly encouraged to stay within the maximum page lengths noted above. Please do not send extraneous material.

Proposal Delivery

Please send six (6) copies of the proposal in addition to the original and including one copy that is clipped together (not bound) so that it can be easily photocopied to:

Outreach Partnership Program
National Institute of Mental Health
6001 Executive Blvd, RM 8187
Bethesda, MD 20892-9669 (for regular mail)
Rockville, MD  20852 (for couriers and express mail)
Phone: 301-443-5005 (only for courier use)
Attention: Outreach Partnership Program Competition

Note: To confirm receipt of a proposal, send an email.

Detailed Proposal Instructions

Organizations with non-profit, tax exempt status can jointly apply to this solicitation. Co-partnering applicants are required in their proposal to indicate the primary organization, and describe the roles, responsibilities, and working relationships of each organization. Note: The identified primary organization will serve as the point of contact with NIMH, will receive the stipend, and will be responsible for all deliverables.

Task 1: Managing the Project
Maximum 2-4 pages + resumes
Total Points: 20

Provide:

  • A description of the organization, including its mission, primary activities, how long it has been in existence, membership size, and any other pertinent details.
  • A description of the geographic area the organization currently reaches through existing activities and/or services.
  • A description of the overlap between the organization’s goals and the goals of the NIMH Outreach Partnership Program.
  • A description of the organization's experience or capability in facilitating science-based education and outreach at the state or local level, and statewide dissemination of science-based information.
  • A description of the organization's experience and capability to perform the reporting requirements of the Program, involving monitoring and supplying information and data about Program-related outreach activities. Describe the methods currently used to monitor and evaluate education and outreach activities.
  • A designated person who will be responsible for the management of the organization's participation in the Program, including accomplishing the tasks and reporting requirements. This person will serve as the primary point of contact with NIMH. This individual should have experience in mental health education and outreach, be involved in the organization's day to day NIMH Outreach Partner activities, and can be the Executive Director of the organization. Describe how the contact person will oversee the Program. Identify a backup contact and indicate any other key staff who will be involved with the Program. Include resumes of the primary and backup contacts.
  • A description of the organization's existing state and local networks, including government. For example, if the organization participates in statewide committees or provides input on policy, service system issues, funding, or evidence-based practice initiatives, please describe.

Task 2: Disseminating NIMH Research Findings and Science-based Educational Materials
Maximum 2-3 pages
Total Points: 30 

Briefly describe:

  • Current local and state information dissemination activities conducted by the organization. Include a brief description of the type(s) of data currently collected related to the reach of these types of activities.
  • A proposed plan for disseminating NIMH research findings, educational materials, and science-based messages about mental disorders throughout the state, including a description of audiences that will be reached and how data will be collected.
  • How this proposed plan will be integrated into the organization's ongoing activities.

Task 3: Conducting Targeted Outreach (Special Project/s) on Child and Adolescent Mental Health and/or Mental Health Disparities
Maximum 2-3 pages
Total Points: 20

Briefly describe:

  • Outreach and education activities addressing mental disorders in children and adolescents and/ or mental health disparities currently or previously conducted by the organization and how these activities were tracked.
  • A proposed plan for implementing outreach activities that addresses mental disorders among children and adolescents and/or mental health disparities as defined by race or ethnicity, age (e.g., older adults), education or income, disability status, geographic location, risk status related to sex and gender, and among other populations identified to be at-risk for health disparities such as immigrants, and military service members and their families. Please include the following:
    • Identify the intended target audience(s), focus area, and specific activities,
    • An overview of the organization's existing partnerships that will enhance the success of this activity,
    • Additional organizations, resources, and networks that would enhance the success of the activity,
    • How NIMH materials will be used in the proposed activities, and how data will be collected to report these activities,
    • A rationale regarding the specific activities planned,
    • How these activities will strike a balance between direct outreach to the target audience(s) and activities aimed at intermediaries/gatekeepers such as health care providers, faith leaders, and school personnel, and
    • How these activities will be integrated into the organization's ongoing activities.

Task 4: Advancing Research
Maximum 2-3 pages
Total Points: 20

Briefly describe:

  • Organization's past and/or current involvement in research promotion and how these activities have been monitored and reported. The proposed plan for promoting volunteer participation in clinical research sponsored by NIMH and NIH.
  • How the organization may be able to act as a resource for universities and research institutions in determining priorities for conducting mental health research in the community and state.
  • How this plan will be integrated into the organization's ongoing activities.
  • Identify any existing relationships with researchers and their roles in the organization's activities.
  • If an established relationship with a researcher(s) exists and there is a mutual desire to collaborate, provide an abridged curriculum vitae (CV) that includes current research involvement, a signed letter of commitment to work jointly on science-based education and outreach, and a brief description of the types of activities planned for collaboration. Note: Applicants are not required to submit the name of a research collaborator if such a relationship does not exist at this time. NIMH will assist Outreach Partners, as appropriate, in identifying research grantees in their state and/or local community. The research collaboration requirement described in Task 4 may not apply to applicant organizations/universities with a primary research focus.

Organizational Capabilities
Maximum 1-2 pages
Total Points: 10

Provide:

Organizational Eligibility 
Attachments

Provide:

  • Evidence that the organization is tax exempt, with a non-profit status under any section of the United States tax code (e.g., copy of a letter from the Internal Revenue Service).
  • Evidence that the organization meets Federal Equal Employment Opportunity requirements.
  • Evidence of an active Central Contractor Registration (CCR) record by indicating organization's DUNS in the Organization and Contacts Form. (Instructions for registering in CCR can be found at the CCR website . Note: A new registration takes 3-5 business days once all information is entered at CCR.)

Appendix Organization and Contacts Information

Organization Information

Organization Name:
Street Address:
City:
State:
Zip Code:
Phone:
Fax:
Website URL:
Email Address:
Tax Identification Number:
DUNS:
Does your organization have an Active record in CCR?: __ Yes __ No
Geographic Reach: What geographic region does your organization serve?
Population Size: What is the size of the population you serve?
Number of Paid staff:
Number of Volunteer Staff:
Membership Size:
Number of Affiliates:
Affiliate Locations:
Number of Board Members:
Composition of Board:

Programs/Services: What types of programs and services does your organization provide? For each selected, please describe the focus and populations addressed.

__Advocacy/Policy:
__Clinical Services:
__Education and Outreach:
__Employment/Vocational Services:
__Family Support:
__Housing Services:
__Information and Referral Services/Helpline:
__Peer Support:
__Telehealth:
__Other, please describe:

Populations Served: What populations does your organization serve?
__Affiliates
__Consumers
__Criminal Justice
__Education
__Faith-based
__Families
__General Public
__Healthcare Providers
__Law Enforcement
__Servicemembers
__Workplace
__Children (under 12 years)
__Youth (13-17 years)
__ Young Adults (18-21 years)
__Adults (22-64 years)
__ Older Adults (above 65 years)
__African Americans
__American Indians/Alaska Natives
__Asian Americans/Pacific Islanders
__Caucasians
__Hispanics/Latinos
__Other (describe):
Joint Application: Is this a joint application: __ Yes __ No
If yes, provide name (s) of partnering organization(s):

Primary Contact Person

Enter contact information for the person who will be responsible for management of the organization's work for the Program and serve as the primary point of contact for NIMH staff. Please also include a resume for this person as an attachment to the proposal.

Prefix:
First Name:
Last Name:
Degree:
Organization:
Title:
Street Address:
City:
State:
Zip Code:
Phone:
Fax:
Email Address:

Backup Contact Person

Enter contact information for the person who will serve as the backup contact for the Program. Please also include a resume for this person as an attachment to the proposal.
Prefix:
First Name:
Last Name:
Degree(s):
Organization:
Title:
Street Address:
City:
State:
Zip Code:
Phone:
Fax:
Email Address:

Executive Director

Enter contact information for the applicant organization's Executive Director or equivalent.
Prefix:
First Name:
Last Name:
Degree(s):
Organization:
Title:
Street Address:
City:
State:
Zip Code:
Phone:
Fax:
Email Address:

Research Collaborator

If relevant, provide contact information for the individual who will serve as research collaborator. Please also include an abridged CV for this person along with a signed letter of commitment as an attachment to the proposal.
Prefix:
First Name:
Last Name:
Degree(s):
Title:
Organization:
Street Address:
City:
State:
Zip Code:
Phone:
Fax:
Email Address: