Principal Investigator:
1. Table of Contents Indicate below the page number(s) of each applicable section of this application. Please use Ariel 11 point font.
Table of Contents...... 1
Title Page...... 2
Scientific Abstract/Summary...... __
Percent Effort...... __
Biographical Sketches...... __
Personal Statement...... __
Positions and Honors...... __
Publications...... __
Research Support...... __
Research Plan...... __
Plain Language Research Summary...... __
Research Facilities Available...... __
References...... __
Budget...... __
Letter of Recommendation...... __
Personal Data...... __
2. Title Page: Indicate the title of your project and your sponsoring institution, including contact information for the principal investigator and his/her sponsor.
Project Title:
Sponsoring Institution:
Principal Investigator
Last Name:First Name:Middle Initial:
Degrees:Year(s) Granted:
Title/Position:Appointment Date:
Department:
Address 1:
Address 2:
City:State:Zip:
Email:Phone:Fax:
I certify that the information contained in this application is correct to the best of my knowledge. I also understand that if any information is falsified, my application may be disqualified.
Applicant Signature ______Date ______
3. Scientific Abstract/Summary: In the space below, briefly describe the research project, technical approach and anticipated results. (Do not use tab returns to create indentation or exceed the space provided below.)
4. Percent Effort: Please indicate below your current percent effort and projected percent effort should you receive this grant.
Current Percent Effort / Projected Percent Effort Under GrantResearch
Administration
Clinical Activities
Teaching
100% / Total / 100%
5. Biographical Sketches: Provide the following information for the principal investigator, sponsor, preceptor, and all key professional personnel. Copy, insert, and complete for all additional personnel. Limit biographical sketch to one (1) page each.
Last Name, First Name / Position/TitleEducation/Training: Begin with baccalaureate or other initial professional education and include post-doctoral training.
Institution and Location / Degree (if applicable) / Year(s) / Field of Study5a. Personal Statement:Briefly describe why your experience and qualifications make you particularly well-suited for your role (e.g., PD/PI, mentor, participating faculty) in the project that is the subject of the application.
Limit to one (1) page.
5b. Positions and Honors: Starting with present position, list, in chronological order, previous employment, experience and honors. Include present membership on any federal government public advisory/grants committee.
PROFESSIONAL EXPERIENCE
Dates / Title / Mentor / Institution and Location5c. Publications: Please include in separate sub headings, original peer reviewed and other (e.g. reviews, commentaries, editorials) publications. (limit to 2 pages)
5d. Research Support: List both selected ongoing and completed research projects for the past three years (Federal or non-Federally-supported). Begin with the projects that are most relevant to the research proposed in this application. Briefly indicate the overall goals of the projects and responsibilities of the key person identified on the Biographical Sketch. Do not include number of person months or direct costs.Limit to a total of two (2) pages.
6. Research Plan:Prepare according to National Institutes of Health 2009 revised PHS 398 guidelines. Begin each section of the Research Plan with a section header (e.g., Introduction, Specific Aims, Research Strategy, etc.). The Research Strategy Section should be composed of three distinct sections – Significance, Innovation, and Approach; the approach section may include preliminary studies. The research plan should include sufficient information needed for evaluation of the project independent of any other document. Be specific and informative and avoid redundancies. Limit to six (6) pages.
7. Plain Language Research Summary: Summarize and explain research project and objectives in lay-terms. Limit to one (1) page.
Project Title:
8. Research Facilities Available: List office, laboratory, major equipment, support staff and clinical facilities available. Limit to one (1) page.
9. References: Include all titles and authors. Limit to one (1) page.
10. Budget: Include itemized budget and justification below (e.g., salary support, equipment and supplies of the investigator). Indirect costs are not allowed. Limit to one (1) page.
Personnel (indicate percent effort and salary) / Year 1 / Year 2Permanent Equipment (Itemize)
Supplies (Group into major categories.)
Other Expenses (Itemize by category and include specific amount for each item.)
Total:
Total Amount Requested (sum of all years and categories covered during award term)
10 a. Budget Justification: Provide any additional justification/explanation required.
11. Letter of Recommendation: Letter of recommendation should be provided from the Division Chief or Department Chair and should outline support of the candidate and his/her research program.Please append the required letter(s) of recommendation to the application and submit the application and letter as one combined PDF file. Limit letter to one (1) page.
Please list below the name, title, and address of the individual writing the letter of recommendation.
Name / Title / Address