Proposal_Intent_(Amendment_2).pdf

PROPOSAL INTENT RESPONSE SHEET

NIHDA201800065

PROPOSAL INTENT RESPONSE SHEET

RFQ NO.: NIHDA201800065

RFQ TITLE: NIMH Outreach Partnership Program

Please review the Request for Quotation (RFQ). Furnish the information requested below and return this page to the Contracting Officer by March 28, 2018.

Your expression of intent is not binding but will greatly assist us in planning for proposal evaluation.

[ ] DO INTEND TO SUBMIT A PROPOSAL

[ ] DO NOT INTEND TO SUBMIT A PROPOSAL FOR THE FOLLOWING REASONS:

Please provide the following information:

Company/Institution Name (print): ___________________________________________________________

Address (print): _____________________________________________________________________________

Name (print): _______________________________________________________________________________

Title (print): ________________________________________________________________________________

Telephone Number and E-mail Address (print clearly):

Names of Collaborating Institutions and Investigators (include Subcontractors and Consultants) (print):

Signature/Date: ____________________________________________________________________________

RETURN THIS SHEET VIA E-MAIL TO:

ATTN: Jeffrey Brown Email: jeffrey.brown@nih.gov mailto:jeffrey.brown@nih.gov