ARNOLD AND MABEL BECKMAN
BECKMAN YOUNG INVESTIGATOR AWARD
LETTER OF INTENT - Information Form
Please complete the required information on this form.
Principal Investigator Name:
Starting Date of Current Appointment (must be in mm/dd/yy format):
Academic Rank or Title
Name of Institution:
Institution City, State, Zip:
Web Site Address:
Citizen of what country?:
Permanent resident of what country?(documentation must be provided with every application):
Brief Descriptive Title of Proposed Research:
Chief Institutional Academic Officer (President, Chancellor, Provost):
Dean of College/School/Division for Participating Academic Unit(s):
If you have any problems, please email firstname.lastname@example.org for assistance.