I. CONTRACTING PARTIES  合同双方

This contract and agreement is entered into by and between The University of Texas Southwestern Medical Center at Dallas, 5323 Harry Hines Boulevard, Dallas, Texas 75235, and _____.

此合同和协议由得克萨斯大学西南医学中心（得克萨斯州达拉斯Harry Hines大街5323号，邮编75235）和 ___ 方订立。

II.STATEMENT OF SERVICES TO BE PERFORMED 执行服务声明

___________ shall provide the services of, who will, under Grant No., UT Southwestern Principal Investigator. [describe services]

__________ 方将提供UT Southwester Principal Investigator（在Grant No.项下）的服务。[描述服务]

III. TERMS OF AGREEMENT  协议条款

This agreement shall be effective through. The contract may be terminated by either party prior to the scheduled termination with thirty (30) days written notice to the other party.

此协议将生效。此合同将在计划终止前30天前可由任何一方以书面的形式通知对方终结合同。

IV.  CONTRACT AMOUNT 合同金额

The total amount of this contract shall not exceed and100 DOLLARS($) per annum.

此合同的总金额将不超过100 美金/年。

V.  BASIS FOR CALCULATING REIMBURSABLE COSTS 计算可补偿费用基础

Salary $（薪水）

Fringe Benefits $（福利）

Total Direct Costs $（总的直接费用）

VI. PAYMENT FOR SERVICES 服务费用

Payment for services performed shall be made on the basis of approved certified vouchers submitted monthly to : Grants Accounting, The University of Texas Southwestern Medical Center at Dallas, 5323 Harry Hines Boulevard, Dallas, Texas 75235-9020. RECEIVING AGENCY: The University of Texas at (component)

所进行的服务费用需用得到许可的票据每月汇至：得克萨斯大学西南医学中心Grant Accounting（得克萨斯州达拉斯Harry Hines大街5323号，邮编75235-9020）接收机构：得克萨斯大学

(UT Contact Name)  得克萨斯大学联系人姓名

Title:  职务

Date:  日期：

PERFOMRING AGENCY: 执行机构：

Title:  职务

Date:  日期：