Compound Application Form

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Name *
Address *
Institutional Address
Please describe the reason why this compound deserves to be evaluated for potential effects on longevity and aging. Rationale may include theoretical ideas or pilot data in nematodes, mice, or humans if available. If you need to include unpublished data, include enough information to permit its evaluation. If you include published data, include a reference citation to the publication(s) from which the data is derived.
Provide a detailed description of the compound being tested and rationale for the protocol proposed. The following should be addressed: (1) Is the substance soluble in DMSO or H2O? (2) Does the compound have any sensitivities such as light or heat? (3) What is the suggested source and supplier of the test material? (4) How expensive would the compound be?
Please provide any additional content you believe may be helpful that was not yet covered in this proposal.
Statement of Understanding *
In submitting this proposal, I agree to the following: I understand that all information presented in the proposal can be freely shared with members of the CITP team during their evaluation of proposals, but will otherwise be considered confidential. If my proposal, or a modification of it (such as altered dosage or frequency of administration) is accepted for inclusion in a research protocol, I will be asked to help evaluate the data and to prepare the data for written and oral publications, for which I will be offered co-authorship. I understand that the CITP intends to submit the results of all CITP-supported studies—regardless of whether they produce data showing positive or negative effects on health status in nematodes—for publication. I understand that data generated by CITP-supported experiments using the compound proposed will be made publicly available and can be used in applications for further research support by anyone. I will also be free to use CITP-generated data in the context of applications for research support or for any other purpose. I acknowledge that the compound proposed may make use of materials that are not yet freely available and whose production depends on proprietary or unpublished methods. If my application is approved for incorporation in the CITP, a mutually acceptable Materials Transfer Agreement that would permit me to provide the CITP with the compound(s) needed for the experimentation will be developed with the institutions involved in this program.