<p> NAVAL MEDICAL CENTER PORTSMOUTH</p><p>Educational Partnership Agreement (EPA) Information Sheet</p><p>Instructions: Navy PI and Non-Navy PI should work together and consolidate their respective information to complete and submit one questionnaire. Fill in each section with as much information as possible. You are not limited by the space provided below. Upon completion, the questionnaire should be submitted to the NMCP CRADA Officer, Ania G. Castillo at [email protected]. For questions, you can reach Ms.Castillo at 757-953-5939.</p><p>Note that per 10 USC 2194, the purpose of an EPA is to encourage and enhance study in scientific disciplines at all levels of education at educational institutions, such as, local educational agency, colleges, universities, and any other non-profit institutions that are dedicated to improving science, mathematics and engineering education. If the intent and involvement of your collaboration is greater than the scope of an EPA, a Cooperative Research and Development Agreement may be the right agreement for you. A separate CRADA information sheet is available at https://nmcp.med.navy.mil/CID/SitePages/Investigator%20Resources.aspx. </p><p>1. Provide a title for the proposed collaborative work: </p><p>2. Provide contact information below NAVY PRINCIPAL NON-NAVY PREFERRED NON-NAVY PRINCIPAL INVESTIGATOR POINT-OF-CONTACT INVESTIGATOR/STUDENT</p><p>Name: Name: Name: Address: Address: Address: Office Code: Phone: Phone: Phone: Fax: Fax: E-mail: E-mail: E-mail: Degree enrolled in: </p><p>3. BACKGROUND INFORMATION ON THE EDUCATIONAL INSTITUTION</p><p>Educational Institution's Address: </p><p>Legal Counsel: </p><p>Partnership Program Manager, if different from POC: </p><p>What are the areas of discipline to be covered by the EPA? </p><p>4. PUBLIC RELEASE SUMMARY</p><p>Write a brief description, preferably in layman’s terms of the intent and nature of the work to be done and how the Collaborators will participate and benefit. </p><p>The Summary is not to be used as a binding requirement of the Agreement. This summary will be used: (1) in internal documents and public releases from the Office of Naval Research; and (2) in internal documents and public releases from both the Navy and Non-Navy Collaborators. </p><p>5. OBJECTIVES OF THE COLLABORATION</p><p>Describe the specific, realizable results or benefits to be gained by each Collaborator at the conclusion of this Agreement. State the desired final outcome by each Collaborator. </p><p>For the Navy Collaborator: For the Non-Navy Collaborator: NAVAL MEDICAL CENTER PORTSMOUTH</p><p>6. TYPES of SUPPORT a. Will NMCP loan laboratory equipment to the institution for any purpose and duration in support of the agreement? Yes No b. Will surplus equipment be transferred to the educational institution? Yes No c. Will NMCP personnel be made available to teach science courses or to assist in the development of science courses and materials for the educational institution? Yes No d. Will NMCP be cooperating with the educational institution in developing a program under which students may be given academic credit for work on research projects? Yes No e. Will NMCP be providing academic and career advice and assistance to students of the institution? Yes No </p>