Partner description questionnaire

Institution name*

Legal address of institution*

Name of department/Center as you would like it to appear on grant

Brief description of center or department

What is it that this department provides to consortium (i.e. large clinical research center, expertise in proteomics, expertise in transgenic technology etc.)

Previous experience of the center in collaborations, multicenter grants*

Ongoing or previous collaborations with any other members of the consortium

Previous experience of the center with technology transfer/drug development

Contact Person for this grant

Contact Person Email

Contact Person â€“ phone number

Contact Person â€“ mailing address

Key individuals â€“ please list only top tier of key individuals here

Name of key individual #1 for this grant

Title of key individual #1

Research interests of key individual #1

Brief summary of experience relevant to grant for key individual #1 (example # manuscripts published, grants administered, clinical trials run, positions â€“ chair of Animal welfare committee etc.)

Name of key individual #2 for this grant

Title of key individual #2

Research interests of key individual #2

Brief summary of experience relevant to grant for key individual #2 (example # manuscripts published, grants administered, clinical trials run, positions â€“ chair of Animal welfare committee etc.)

Name of key individual #3 for this grant

Title of key individual #3

Research interests of key individual #3

Brief summary of experience relevant to grant for key individual #3 (example # manuscripts published, grants administered, clinical trials run, positions â€“ chair of Animal welfare committee etc.)

Name of key individual #4 for this grant

Title of key individual #4

Research interests of key individual #4

Brief summary of experience relevant to grant for key individual #4 (example # manuscripts published, grants administered, clinical trials run, positions â€“ chair of Animal welfare committee etc.)

Name of key individual #5 for this grant

Title of key individual #5

Research interests of key individual #5

Brief summary of experience relevant to grant for key individual #5 (example # manuscripts published, grants administered, clinical trials run, positions â€“ chair of Animal welfare committee etc.)

List 4 references relevant to this grant

List personnel resources to be used for this grant be overly inclusive (i.e. 4 technicians, 2 post docs etc)

List major resources to be used for this grant (i.e. mass spectrometry facility, transgenic

Partner description questionnaire

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