> **Date of Pre-Proposal (MM/DD/YY):**
> \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
>
> **Reagent Request:**
> \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
>
> **Purpose/Objective:** (please provide a brief one page maximum
> description of the proposed project. Include justification and
> relevant background)

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Principal Investigator:

+------------+---------------------------------------------------------+
| > Name:    |                                                         |
+------------+---------------------------------------------------------+
| >          |                                                         |
|  Position: |                                                         |
+------------+---------------------------------------------------------+
| > Address: |                                                         |
+------------+---------------------------------------------------------+
| > State:   |                                                         |
+------------+---------------------------------------------------------+
| > Zip      |                                                         |
| > Code:    |                                                         |
+------------+---------------------------------------------------------+
| >          |                                                         |
| Telephone: |                                                         |
+------------+---------------------------------------------------------+
| > Fax:     |                                                         |
+------------+---------------------------------------------------------+
| > E-mail:  |                                                         |
+------------+---------------------------------------------------------+

Organization/Company:

+----------+-----------------------------------------------------------+
| > Name:  |                                                           |
+----------+-----------------------------------------------------------+
| >        |                                                           |
| Address: |                                                           |
+----------+-----------------------------------------------------------+
| > State  |                                                           |
+----------+-----------------------------------------------------------+
| > ZIP    |                                                           |
| > Code   |                                                           |
+----------+-----------------------------------------------------------+

Description of Reagents Available for Sequencing:

-   Number of Isolates

-   Subtype

-   Host

-   Collection Date

-   Storage Method

-   Amplification Method

> **Expectations for Collaboration:** (please include: (a) number of
> isolates to be processed during project period; and (b) rate of
> processing; i.e. -- how many isolates per month can collaborator ship
> to TIGR)

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Agree to NIAID's Microbial Sequencing Center Data Release Policy:

> Yes \_\_\_\_\_\_\_\_\_ No \_\_\_\_\_\_\_\_\_

Principal Investigator Signature:

NIAID Project Officer

Maria Y. Giovanni, Ph.D.

Assistant Director for Microbial Genomics & Advanced Technology

Division of Microbiology and Infectious Diseases

NIAID/NIH/DHHS

6610 Rockledge Dr. MSC 6603; Room 6007

Bethesda, MD 20892-6603

301-496-1884 Phone

301-480-4528 FAX

mgiovanni@niaid.nih.gov