PRINCIPAL INVESTIGATOR (LAST, FIRST, MIDDLE):

PEOPLE & PLACES

Refer to the PCORI Application Guidelines for guidance.

PROFESSIONAL PROFILE/BIOSKETCH
(Provide the following information for the PI, key personnel, and other significant contributors. Follow this format for each person. Use continuation pages as needed to provide the required information. Do not exceed four pages per person. Refer to PCORI Review Criterion 7 for additional guidance.
Mouse over underlined subheadings for additional instruction.)

Name (Last, First): Position Title:

EDUCATION/TRAINING

INSTITUTION AND LOCATION / DEGREE
(if applicable) / DATE / FIELD OF STUDY

PROFESSIONAL STATEMENT

EMPLOYMENT AND POSITIONS HELD

INSTITUTION AND LOCATION / RESPONSIBILITIES / DATE

HONORS

SELECTED PEER-REVIEWED PUBLICATIONS

OTHER SELECTED PUBLICATIONS

PUBLIC SPEAKING OR PRESENTATIONS

RESEARCH SUPPORT

INSTITUTION AND LOCATION / RESPONSIBILITIES / DATE

OTHER

PATIENT AND STAKEHOLDER ENGAGEMENT PLAN
(Use continuation pages as needed to provide the required information. Limit 4 pages. Mouse over underlined subheadings for additional instruction. Refer to PCORI Review Criterion 7 and the PCORI Application Guidelines for additional guidance.)

IDENTIFICATION OF KEY STAKEHOLDERS

DESCRIPTION OF ENGAGEMENT FREQUENCY

DESCRIPTION OF ENGAGEMENT TYPE

BARRIERS ASSESSMENT


PROJECT/PERFORMANCE SITE(S) AND RESOURCES
(Use continuation pages as needed to provide the required information. Add additional facilities as necessary. Limit 15 pages.
Mouse over underlined subheadings for additional information. Refer to the PCORI Application Guidelines for additional guidance.)

PRIMARY RESEARCH FACILITY DESCRIPTION

Organizational name:

Street address:

City, county, state, & ZIP code:

Congressional district:

Additional Information:

FACILITY 2 DESCRIPTION:

Organizational name:

Street address:

City, county, state, & ZIP code:

Congressional district:

Additional Information:

1

PCORI Documentation of People & Places