Author's Name:

Title of Software Program:

Contributor:

Institution:

Address:

Telephone Number:

Fax Number:

Email Address:

Type of Program:

Application
Utility
Other (Please describe)

Category (e.g., cardiology, pathology, etc.):

Level of potential users:

Field of Interest(s):

Developed for: (computer format)

in the language(s) or authoring program: (please describe)

to run under: (operating system)

Available on:

Floppy Disk
CD-ROM
Internet - Web Site Address

Special Hardware Required:

Memory Required:

Documentation:

None
Minimal
Self-documenting
Extensive

Source Code Available?

Yes
No

Stage of Development:

Design Complete
Ready to Beta Test
In-house only
Collaboration welcomed

Is the program in use?

Yes

For how long?
At how many sites?

No

Is the contributor available for user inquiries?

Yes
No

Distributed by:

Cost of program:

Demonstration disk available?

Yes - Cost
No