<p> MDC FUND REQUEST FORM General Information PRIMARY INVESTIGATOR: DATE OF APPLICATION: Email: Phone: </p><p>MENTOR (If Fellow/Resident/Student): AMOUNT REQUESTED (up to $10,000): </p><p>CO-INVESTIGATOR(S): </p><p>PROJECT TITLE: </p><p>EXPECTED PROJECT DURATION: Start date: ______End date: ______Project Details SIGNIFICANCE AND SPECIFIC AIMS (1 page):</p><p>HOW WILL PROJECT FORWARD THE MISSION OF THE MOVEMENT DISORDERS CENTER? (1/2 page)</p><p>PROJECT OBJECTIVES/METHODS (2 Pages):</p><p>FUTURE DIRECTIONS OF THIS RESEARCH (1/2 Page): [Type text] [Type text] [Type text] LITERATURE CITED: (1 page)</p><p>TIMELINE, BUDGET AND BUDGET JUSTIFICATION (1 Page):</p><p>P.I. Signature: ______Date: ______</p><p>Date Discussed by committee: ______</p><p>Committee members:</p><p>Approved by committee majority vote? ☐ Yes ☐ No If no, committee requests additional information or revisions before considering for funding? ☐ Yes ☐ No</p><p>☐ Project not appropriate for use of MDC funds.</p><p>Notes/Comments (include requests, questions, feedback for applicants; may include suggestions for project regardless of funding decision. Also if there are improvements to be made to this form and application process.):</p>
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