Date:

Project Title:

PRINCIPAL US APPLICANT:

Name of Individual/ Title

Institutional Affiliation (Required)

Mailing Address

City		State / Province		Zip Code
E-mail		Telephone		Fax

PRINCIPAL CHINESE APPLICANT:

Name of Individual/ Title

Institutional Affiliation (Required)

Mailing Address

City		State / Province		Zip Code
E-mail		Telephone		Fax

CORRESPONDENCE CONTACT:

Designate one applicant shown above as recipient of all correspondence regarding this application. Check one:

      US Applicant            Chinese Applicant

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