Part Two Table of Contents Form 7
Part Two Table of Contents – Form 7
Applicant OrganizationPI Last Name, First Name
Form / Form Name / Page
1 / Face Page...... / 1
1-S / Face Page - Subcontracting Organization(s)*......
2 / Staff, Collaborators, Consultants and Contributors......
3 / Independent Oversight Panel......
4 / Acronyms and Abbreviations Used in Application......
5 / Lay Abstract(do not exceed 300 words)......
6 / Scientific Abstract(do not exceed 1 page)......
7 / Table of Contents......
8 / Budget and Justification - Applicant......
8 / Budget and Justification – Subapplicant Organization(s)*......
9 / Biographical Sketch(es)(do not exceed 3 pages each)......
10 / Facilities and Resources(do not exceed 2 pages each)......
11 / Other Research Support......
12 / Introduction(do not exceed 3 pages)*......
13 / Workplan (do not exceed 35 pages for sections a-c)......
Summary and Detail......
a. Significance......
b. Background and Preliminary Results ......
c. Research and Development Plan ......
d. Milestones and Timeline ......
e. Project Management and Coordination Strategy......
f. Literature Cited......
14 / Human Subjects– at least one for each applicant and sub-applicant......
15 / Vertebrate Animals– at least one for each applicant and sub-applicant......
16 / Human Stem Cells– at least one for each applicant and sub-applicant......
Appendix Material......
* Indicate “N/A” if not applicable.
Part Two Biographical Sketch – Form 9
NAME / POSITION/TITLEEDUCATION/TRAINING (Begin with baccalaureate or other professional education, and include postdoctoral training)
ORGANIZATION AND LOCATION / DEGREE / YEAR(s) / FIELD OF STUDY
A. Personal Statement.
B. Positions and Honors.
C. Selected peer-reviewed publications or manuscripts in press (in chronological order) from a total of ______.
1
University of RochesterJohn Smith
Part Two Facilities and Resources – Form 10
Laboratory:
Clinical:
Animal:
Computer:
Office:
Other:
MAJOR EQUIPMENT:
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University of RochesterJohn Smith
Part Two Other Support – Form 11
NAME OF KEY PERSONNEL:
Check here if this person has no other source of Active or Pending support:
TITLE OF PROJECT:
Check here to indicate whether this support is Active or Pending: ACTIVE PENDING
BRIEF PROJECT DESCRIPTION:
NAME OF PROJECT PI:
FUNDING AGENCY:
AWARD # (e.g., NIH 5R01GM000000-01):
PERIOD OF SUPPORT (Start and End Dates): -
PROFESSIONAL EFFORT:%
THIS PROJECT INVOLVES STEM CELL RESEARCH: *YES NO
*For any “Yes” answer, list the specific aims of the project and explain the distinction between the project and this NYS-funded contract.
THIS PROJECT OVERLAPS A RESEARCH AIM OR A BUDGETARY ITEM IN THE APPLICATION:
**YES NO
**For any “Yes” answer, provide the intended resolution if the project is funded.
1
University of RochesterJohn Smith
Part Two Introduction – Form 12
1
[ ][ ]
University of RochesterJohn Smith
1
University of RochesterJohn Smith
Part Two WORK PLAN – Form 13
SUMMARY
PROJECT NAME:______
CONTRACTOR SFS PAYEE NAME:______
CONTRACT PERIOD:From:______
To:______
Provide an overview of the project including goals, tasks, desired outcomes and performance measures:Part Two WORK PLAN – Form 13
DETAIL
OBJECTIVE / BUDGET CATEGORY/ DELIVERABLE(if applicable) / TASKS / PERFORMANCE MEASURES
1: / a. / i.
ii.
iii.
b. / i.
ii.
iii.
c. / i.
ii.
iii.
Part Two WORK PLAN – Form 13
DETAIL
OBJECTIVE / BUDGET CATEGORY/ DELIVERABLE(if applicable) / TASKS / PERFORMANCE MEASURES
2: / a. / i.
ii.
iii.
b. / i.
ii.
iii.
c. / i.
ii.
iii.
Part Two WORK PLAN – Form 13
DETAIL
OBJECTIVE / BUDGET CATEGORY/ DELIVERABLE(if applicable) / TASKS / PERFORMANCE MEASURES
3: / a. / i.
ii.
iii.
b. / i.
ii.
iii.
c. / i.
ii.
iii.
1
University of RochesterJohn Smith
Part Two Workplan – Form 13 – Narrative Parts a-f
1
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University of RochesterJohn Smith
Part Two Human Subjects – Form 14
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University of RochesterJohn Smith
SECTION A:
1.Applicant/Sub-applicant Organization:
2.Are Human Subjects involved?YesNo
3.Is the project Exempt from federal regulations?YesNo
4.If YES to #3, what is the Exemption number?1 2 3 4 5 6
5.If NO to #3, is the IRB review Pending? YesNo
6.IRB Approval Date (leave blank only if Yes to #5):
7.IRB Protocol Approval Number:
8.OHRP Federal-wide Assurance Number:
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University of RochesterJohn Smith
SECTION B – NARRATIVE (use additional pages if necessary):
1
University of RochesterJohn Smith
Part Two Vertebrate Animals – Form 15
SECTION A:
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University of RochesterJohn Smith
1.Applicant/Sub-applicant Organization:
2.Are Vertebrate Animals involved?Yes No
3.Is the IACUC review Pending?Yes No
4.IACUC Approval Date (leave blank only if YES to #3):
5.IACUC Protocol Approval Number:
6.Animal Welfare (OLAW) Assurance Number:
7.USDA Registration Number (if applicable to species):
1
University of RochesterJohn Smith
SECTION B – NARRATIVE (use additional pages if necessary):
1
University of RochesterJohn Smith
Part Two Human Stem Cells – Form 16
SECTION A:
1.Applicant/Sub-applicant Organization:
2.Are Human Stem Cells involved?YesNo
3.Is the project Exempt under NAS or ISSCR?YesNo
4.If YES to #3, check the appropriate exemption:NAS 1.3(a) ISSCR Category 1
5.If NO to #3, is the SCRO review pending?YesNo
6.SCRO Approval Date (leave blank only if NO to #5):
7.SCRO Protocol Approval Number:
SECTION B – NARRATIVE (use additional pages if necessary):
1