IN RESPONSE TO RFP-NIH-___________________________________

TITLE: ______________________________________________________

OFFEROR (Primary organization/institution):

Name and Address:

PRINCIPAL INVESTIGATOR:

OFFEROR PERSONNEL Name (Last, First, Initial) and Degree(s)*

SUBCONTRACTOR ORGANIZATIONS (If more than one, list each organization and its personnel separately):

Name and Address:

PRINCIPAL INVESTIGATOR:

SUBCONTRACTOR PERSONNEL Name (Last, First, Initial) and Degree(s)*

COLLABORATORS or CONSULTANTS:

Name [Last, First, Initial) Degree(s)] Organization

* List all co-investigators/key personnel