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To facilitate identification of non-governmental foundation funding for your research, please provide some specifics about your work below:

First Name

Last name

Your email address

Your work phone number

(format: 614-123-4567)

Your terminal degree(s)

(e.g., PhD, MPH / MD, JD)

Your department/unit on campus

(e.g., Division of Human Genetics, Internal Medicine, Medical Center)

Your professional title(s)

(e.g., Associate Professor and Director)

Your track (if faculty)

(i.e., Tenure-track, Research-track, or Clinical-track)

Clinical

Tenure

Research

Prior/Current Experience with Private Foundation Funding

Please list any private foundations that have funded your research in the past:

(if none, write NA)

Please list any private foundations from whom you plan to seek funding in the coming months:

(e.g., Alfred P. Sloan Foundation, Research Fellowship program)

List any upcoming conference presentations for which you are scheduled:

Private foundation program officers regularly attend conferences to learn about emerging areas of study. We can research the foundations that might be in attendance at your upcoming presentations and potentially facilitate in-person meetings.

About Your Research:

Are you interested in meeting one-on-on (in person or via phone) with a Foundation Relations team member to discuss your research?

This meeting/call will be to establish a working relationship, identify potential funding opportunities, and discuss funding strategies aligned with your research field.

Yes

No

Provide a brief description of your current research interests:

When you succeed, who will you help?

(Your target stakeholders, audience, and/or population.)

List some keywords/phrases/tags that best describe your current or emerging research interests:

(This information will help us to identify potential funding opportunities for your research.)

Keyword 1

Keyword 2

Keyword 3

Keyword 4

Keyword 5

Keyword 6

Keyword 7

Keyword 8