Name (PI): *

CO/MPI(s):

Working Title: *

Subspecialty:
Autoimmune Basic Science Behavioral Neurology Epilepsy General (more than one area) Neurology Headache/Pain Movement Disorders NES Neuro-Hospitalists Neuro-Immunology Neuro-Muscular Neuro-Oncology Neuro-Ophthalmology Neuro-Palliative Care Neurogenetics Neuroimaging

Grant Sponsor: (who is paying CU?)*

Program Announcement # or link: *

Funding Type: *
Grant Industry-Funded Gift Fund IPA

Sponsor Due Date: (Enter N/A if not applicable) *

Is this a resubmission? *
Yes No

Is CU the prime recipient (direct applicant) of this grant? *
Yes No

If No, please enter the name of the Prime Recipient (PTE).
PTE Name:

Is CU issuing a subaward to another entity? *
Yes No

If Yes, please enter the name(s) of the subrecipient(s).
Subrecipient Name(s):

Human Subjects Research? *
https://grants.nih.gov/policy/humansubjects/hs-decision.htm
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Vertebrate Animal Research? *
Yes No

Outgoing Subaward on Grant? (Will you be sub-awarding work to outside of CU Anschutz?) *
Yes No

Subawardee(s) Sub-I name(s) and organization(s):

Is this a clinical trial? *
https://grants.nih.gov/ct-decision/index.htm
Yes No

Would you like to set up a budget/planning meeting? *
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