Pilot Grant Proposal
TITLE OF PROJECT(Do not exceed 81 characters, including spaces and punctuation.)
PRINCIPAL INVESTIGATOR
NAME (Last, first, middle) / DEGREE(S)
POSITION TITLE / MAILING ADDRESS (Street, city, state, zip code)
DEPARTMENT, SERVICE, LABORATORY, OR EQUIVALENT
MAJOR SUBDIVISION
TELEPHONE AND FAX (Area code, number and extension) / E-MAIL ADDRESS:
TEL: / FAX:
INSTITUTION
Name
BUDGET SUMMARY
DATES OF PROPOSED PERIOD OF
SUPPORT (month, day, year—MM/DD/YY) / COSTS REQUESTED FOR INITIAL
BUDGET PERIOD (Year 1) / COSTS REQUESTED FOR PROPOSED
PERIOD OF SUPPORT
From / Through / Direct Costs ($) / Direct Costs ($)
OTHER
HUMAN SUBJECTS RESEARCH No Yes / VERTEBRATE ANIMALS No Yes
If “Yes”, Human Subjects Assurance No. / If “Yes,” IACUC Approval Date / Animal welfare assurance no.
Principal Investigator (Last, First, Middle):
DESCRIPTION: Describe concisely the research design and methods for achieving your goals. Describe the rationale and techniques you will use to pursue your goals. Describe how you plan to utilize the Core(s) and how this will enhance the prospects for obtaining extramural funding. DO NOT EXCEED THE SPACE PROVIDED.
PERFORMANCE SITE(S) (organization, city, state)
Principal Investigator (Last, First, Middle):
PROJECT PERSONNEL. List all personnel in alphabetical order, last name first.
Name / Organization / Role on Project
OTHER SIGNIFICANT CONTRIBUTORS
Name / Organization / Role on Project
Human Embryonic Stem Cells / No / Yes
If the proposed project involves human embryonic stem cells, list below the registration number of the specific cell line(s) from the following list: Use continuation pages as needed.
If a specific line cannot be referenced at this time, include a statement that one from the Registry will be used.
Cell Line
Program Director/Principal Investigator (Last, First, Middle):
The name of the program director/principal investigator must be provided at the top of each printed page and each continuation page.

PILOT GRANT

TABLE OF CONTENTS

Page Numbers
Face Page...... / 1
Description, Project/Performance Sites, Senior/Key Personnel, Other Significant Contributors, and Human Embryonic Stem Cells / 2
Table of Contents...... / 4
Detailed Budget for Proposed Period of Support......
BiographicalSketch – Principal Investigator (Not to exceed four pages)......
OtherBiographicalSketches (Not to exceed four pages each – Consultants, Mentor)......
Resources......
Research Plan......
1.Specific Aims ......
2.Research Strategy ......
3.References Cited......
4.Protection of Human Subjects......
5.Inclusion of Women and Minorities......
6.Targeted/Planned Enrollment Table......
7.Inclusion of Children......
8.Vertebrate Animals......
9.Select Agent Research......
10.Letters of Support (e.g., Consultants, Mentors, Chairs)......
11.Resource Sharing Plan (s)......
Principal Investigator (Last, First, Middle):
DETAILED BUDGET FOR PROPOSED PERIOD OF SUPPORT
DIRECT COSTS ONLY
(follow standard R01 application instructions) / FROM / THROUGH
PERSONNEL (Applicant organization only) / Months Devoted to Project / DOLLAR AMOUNT REQUESTED (omit cents)
NAME / ROLE ON
PROJECT / Cal.
Mnths / Acad.
Mnths / Summer
Mnths / INST.BASE
SALARY / SALARY
REQUESTED / FRINGE
BENEFITS / TOTAL
Principal
Investigator
SUBTOTALS
CORE USAGE (Itemize the expenses)
EQUIPMENT (Itemize)
NOT ALLOWED
SUPPLIES (Itemize by category)
TRAVEL
OTHER EXPENSES (Itemize by category)
TOTAL DIRECT COSTS FOR INITIAL BUDGET PERIOD (Year 1) transfer to Face Page / $

Smooth Muscle Plasticity COBRE Phase III Pilot Grant Application ___

Principal Investigator (Last, First, Middle):
RESOURCES
FACILITIES: Specify the facilities to be used for the conduct of the proposed research. Indicate the performance sites and describe capacities, pertinent capabilities, relative proximity, and extent of availability to the project. If research involving Select Agent(s) will occur at any performance site(s), the biocontainment resources available at each site should be described. Under “Other,” identify support services such as machine shop, electronics shop, and specify the extent to which they will be available to the project.
Laboratory:
Clinical:
Animal:
Computer:
Office:
Other:
MAJOR EQUIPMENT: List the most important equipment items already available for this project, noting the location and pertinent capabilities of each.
Principal Investigator (Last, First, Middle):

Research Plan (not to exceed 5 pages)

Principal Investigator (Last, First, Middle):
This form should be the last page of your document.
PERSONAL DATA ON
PRINCIPAL INVESTIGATOR
The Public Health Service has a continuing commitment to monitor the operation of its review and award processes to detect—and deal appropriately with—any instances of real or apparent inequities with respect to age, sex, race, or ethnicity of the proposed principal investigator.
To provide the PHS with the information it needs for this important task, complete the form below and attach it to the signed original of the application after the Checklist.
Upon receipt of the application, this form will be separated from the application. This form will not be duplicated, and it will not be a part of the review process. Data will be confidential. The PHS requests the last four digits of the Social Security Number for accurate identification, referral, and review of applications and for management of PHS grant programs. Although the provision of this portion of the Social Security Number is voluntary, providing this information may improve both the accuracy and speed of processing the application. Please be aware that no individual will be denied any right, benefit, or privilege provided by law because of refusal to disclose this section of the Social Security Number. The PHS requests the last four digits of the Social Security Number under Sections 301(a) and 487 of the PHS Acts as amended (42 U.S.C 241a and U.S.C. 288). All analyses conducted on the date of birth, gender, race and/or ethnic origin data will report aggregate statistical findings only and will not identify individuals. If you decline to provide this information, it will in no way affect consideration of your application. Your cooperation will be appreciated.
DATE OF BIRTH (MM/DD/YY) / SEX/GENDER
Female Male
SOCIAL SECURITY NUMBER
(last 4 digits only) / XXX-XX-
ETHNICITY
1. Do you consider yourself to be Hispanic or Latino? (See definition below.) Select one.
Hispanic or Latino. A person of Mexican, Puerto Rican, Cuban, South or Central American, or other Spanish culture or origin, regardless of race. The term, “Spanish origin,” can be used in addition to “Hispanic or Latino.”
Hispanic or Latino
Not Hispanic or Latino
RACE
2. What race do you consider yourself to be? Select one or more of the following.
American Indian or Alaska Native. A person having origins in any of the original peoples of North, Central, or South America, and who maintains tribal affiliation or community attachment.
Asian. A person having origins in any of the original peoples of the Far East, Southeast Asia, or the
Indian subcontinent, including, for example, Cambodia, China, India, Japan, Korea, Malaysia, Pakistan, the Philippine
Islands, Thailand, and Vietnam. (Note: Individuals from the Philippine Islands have been recorded as Pacific Islanders in previous data collection strategies.)
Black or African American. A person having origins in any of the black racial groups of Africa. Terms such as “Haitian” or “Negro” can be used in addition to “Black” or “African American.”
Native Hawaiian or Other Pacific Islander. A person having origins in any of the original peoples of Hawaii, Guam, Samoa, or other Pacific Islands.
White. A person having origins in any of the original peoples of Europe, the Middle East, or North Africa.
Check here if you do not wish to provide some or all of the above information.

Smooth Muscle Plasticity COBRE Phase III Pilot Grant Application ___