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* 1. Which of the following disease categories are in your area of expertise or personal / professional experience (check all that apply)?

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* 2. What types of research are in your area of expertise or personal / professional experience (check all that apply)?

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* 3. In which of the following categories do you have personal / professional experience or do you have a specific interest (check all that apply)?

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* 4. Have you ever conducted, or been involved with, repurposing research, testing approved drugs, devices or nutraceuticals in a new indication or revising existing diagnostics or treatment protocols to improve patient outcomes (check all that apply)?

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* 5. Which of the following types of other research experience do you have (check all that apply)?

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* 6. What types of other research-related experience have you had (check all that apply)?

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* 7. Do you have experience working with formation stage, seed stage or early stage companies developing pre-market drugs, medical devices or other regulated technologies?

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* 8. At what type of institution / organization do you work (check all that apply)?

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* 9. Would you like to be in Cures Within Reach's pool of Grant Review Committee members and Science Advisors? This group is periodically asked to review Letter of Intent (LOI) submissions and/or full proposals on our grants management platform, ProposalCentral, to help determine if a) the repurposing research proposals fit within the mission and goals of Cures Within Reach, b) the LOI ranks high enough to request a full grant submission, and/or c) the full proposal is strong enough to support a grant from Cures Within Reach.

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* 10. For demographic purposes, Cures Within Reach would like to know your ethnicity. This is for internal use only. Check all that apply.

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* 11. Please include your contact information, so that we have up-to-date information:

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