ARNOLD AND MABEL BECKMAN FOUNDATION
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

Department

Telephone Number

Name of Institution:

Institution Address:

Institution City, State, Zip:

E-mail Address:

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:


Principal Investigator:

Signature: __________________________________________________________________________

Date


Institutional Endorsements:

Chief Institutional Academic Officer (President, Chancellor, Provost):

Name:

Signature: __________________________________________________________________________

Title:

Dean of College/School/Division for Participating Academic Unit(s):

Name:

Signature: __________________________________________________________________________

Title:

Please review your print-out before leaving the Principal Investigator Information page. Make any necessary changes and then print again.


If you have any problems, please email murphy@beckman-foundation.com for assistance.
Thank You