SMRI Annual Report Form
* = required

If your grant is a Treatment Trial grant, please DO NOT use this form to submit your progress report.
Please use the quarterly report form or contact Ms. Marte for further instructions.

*GrantID:
*Primary Investigator First Name:
*Last (Family) Name:
*Type of Grant: Research Grant
Drug Development Grant
Neurovirology Grant
BPN Data Collection
Special Project Grant
Postdoctoral Fellowship
*Reporting Period (since last report to date): Start Date (mm/dd/yyyy):
End Date (mm/dd/yyyy):
*Type of Report: Annual Reports
Interim Reports
Final Reports
Most Recent Date of IRB Approval (mm/dd/yyyy):
Date of IRB Expiration (mm/dd/yyyy):
*Title of Project:

*Brief update (500-1,000 words) on what you accomplished during this past funding period (please include notable scientific and safety findings):

Financial Report of Expenditures:
*Salaries (please indicate job title and salary for each person):
*Supplies (please indicate type of supply and cost of each):
*Equipment (please indicate type of equipment and cost of each):
Other Expense:
*Total Balance Forwarded From Previous Year(s) (US $):
*Total Cash Payments Received From SMRI For This Period/Year (US $):
*Total Amount Spent (US $):
*Total Amount Unspent (US $):

Please remember to fax the original, signed and dated (by the appropriate finance department representative certifying that the figures are accurate), financial report of expenditures issued by your institution (all figures must be in U.S. dollars). Please also attach a copy of the current IRB approval letter (all foreign IRB approval letters must be translated into English). Please note that we do not accept a print out of this form as your original financial report. Please fax (301-571-0768) your original financial report and IRB approval letter to the following: To Ms. Rhoda Marte if your grant is a Research Grant, Drug Development Grant, and Neurovirology Grant only. Please use the appropriate fax cover sheet and include grant ID for response. Fax Cover for Ms. Marte Note: you need Adobe Acrobat 6.0 to open these fax covers.

Submit form: