Intent to Submit - Material Transfer / Data Usage / Non-Disclosure Agreement / Others

Submitter's Name*

PI Last Name, First Name*

If submitting a request as a fellow/trainee, you must include the name of your DEM Faculty Mentor under the PI Name.

DEM Faculty Mentor name

Only if submitting a request as a fellow/trainee

PI Email*

Type of Agreement

Select or enter value

Role on project?

Select or enter value

Which Department will be submitting the proposal

Sponsor Name

Project Title

Estimated Project Start Date

Estimated length of project

Link to Funding Opportunity

Submission Deadline

Upload relevant documents

File Upload

Drag and drop files here or

Please pick one answer below that best describes the scope of work you will be completing with the other entity:*

You and/or the other entity will be sharing confidential information that you and/or the other party would like to protect from further disclosure.

NIH Certificate of Confidentiality

CU Anschutz Information

(If no faculty member, please default to your primary contact)

CU Faculty/Staff Contact Name*

First Name, Last Name

CU Faculty/Staff Email*

Please do not submit a generic email address. It needs to be a university faculty member's email address

CU Faculty/Staff Title*

Address Line, City, State, Zip Code

Please provide the IRB protocol number under which this material was collected or will be used.*

If NA - please provide explanation below

Other Party Information

(If no faculty member, please default to your primary contact)

Contract Admin/Primary Contact Name*

First Name, Last name

Admin/Primary Email*

Who will be disclosing confidential information?*

CU Denver Anschutz

Other Party

Both CU Denver Anschutz and Other Party

Since you plan on disclosing confidential information to the other party, will you contractually agree to mark or label written confidential information as confidential?

Yes, I will agree to this.

Please try to omit this language, but I am ultimately OK accepting this language.

No, I will not agree to mark this information and I will walk away from the contract if not omitted.

Since you plan on disclosing confidential information to the other party, will you contractually agree to reduce to writing and mark as confidential any confidential information disclosed verbally to the other party?

Yes, I will agree to this.

Please try to omit this language, but I am ultimately OK accepting this language.

No, I will not agree to write this information down and label as confidential. I will walk away from the contract if not omitted.

Please describe what information either you or the company seek to protect.*

Editable version of the CDA/NDA (if applicable)

Upload File below

Consent form

Is there any other information you would like CRAO to know about this agreement?

Notes

Send me a copy of my responses

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