K-INBRE Partnering Program Application

Visitor Information
Visitor Name
Home Address
City
State
Zip Code
Phone
E-mail
Visitor status	Student
	Faculty

Host Faculty Information
Host Faculty Name
University
University Address
City
State
Zip Code
Phone
E-mail

Estimated Number of Days at Host Institution
Dates of Planned Visit

Reason for Scientific Visit
Reason for Scientific visit including a brief introduction of the project, a letter of support from the Host Faculty, and a written commitment to cite the NCRR (NIH) sponsored Kansas IDeA Network of Biomedical Research Excellence (P20 RR016475) in any publication or presentation forthcoming as a result of this visit. Students should provide a letter of support from their faculty mentor at the home institution.

*Please paste the Introduction of the Project* here**
*Please paste the Letter of Support from the Host Faculty* here**
Please paste written commitment to cite the NCRR (NIH) sponsored Kansas IDeA Network of Biomedical Research Excellence (P20 RR016475) in any publication or presentation forthcoming as a result of this visit here

Letters of Support and Commitment to Cite may be Sent To: Attn: Heiata Chapman University of Kansas Medical Center Mail stop 3050 3901 Rainbow Blvd. Kansas City, KS 66160 Fax# (913) 588-7180 hchapman@kumc.edu

For questions or more information, please contact Heiata Chapman at hchapman@kumc.edu or (913) 588-7170.

Visitor Information