UNIVERSITY OF ILLINOIS COLLEGE OF MEDICINE AT ROCKFORD

Office of Research

BASIC RESEARCH BRIDGE FUNDING

Application

GRANT CATEGORY (check one)

☐Basic Science Research

☐Clinical Research

☐Public/Community Health Research

☐Behavioral Science Research

  1. TITLE OF PROEJCT Click or tap here to enter text.
  1. Name of Applicant and Department
  1. Name and contact information for ALL individuals on the project including title, office address, telephone number and e-mail address. Denote project leader with an asterisk.

Name / Title / Office Address / Telephone
Number / E-mail
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  1. DEPARTMENT CONTACT (Business Manager):

Last Name: Click or tap here to enter text.First Name: Click or tap here to enter text.

Email: Click or tap here to enter text.Phone: Click or tap here to enter text.

  1. TOTAL AMOUNT OF GRANT FUNDS REQUESTED: Click or tap here to enter text.
  1. ANTICIPATED PROJECT DATES: Click or tap here to enter text.
  1. APPROVALS AND CERTIFICATIONS:

Human Subjects or Tissues will be used:

IRB approval # Click or tap here to enter text.Date Click or tap here to enter text.

Animal subjects will be used:

BRC approval # Click or tap here to enter text.DateClick or tap here to enter text.

Recombination DNA is Involved:

IBC approval #Click or tap here to enter text.DateClick or tap here to enter text.

  1. APPLICANT AGREEMENT

I certify that I will abide by all grant conditions if funded.

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Investigator’s NameDate

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Signed NameDate

I certify that the department will provide necessary space and administrative support for this project.

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Department’s Head NameDate

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Department’s Head Signature Date

PROJECT NARRATIVE

  1. ABSTRACT – Summarize the proposed research outlining succinctly the objective and methodology. Maximum 200 words.

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  1. PROJECT AIM AND HYPOTHESIS – Summarize project aims and hypotheses. Include accomplishments of most recent funding period that needs bridge funding.

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  1. BACKGROUND AND RATIONALE – This should be a brief, critical review of the context of this proposal to current knowledge in the field.

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  1. APPROACH – Provide brief details of the planned research using the bridge funding. Include how the research will strength the specific aims of the planned external funding. Include anticipated results and potential pitfalls, if any.

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  1. LEVERAGING – Describe how the proposed results from this study will be leveraged into extramural grant(s) and other important outcomes. Identify specific sponsors, programs, deadlines and planned timeline for submission.

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  1. REFERENCES – Not included in three-page limit of the application.

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  1. BUDGET

Project Period: Click or tap here to enter text.

PERSONNEL
NAME AND TITLE / TYPE OF APPOINTMENT / % EFFORT ON / Requested Salary / Fringe Rate / Total Salary
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TOTAL PERSONNEL COSTS: Click or tap here to enter text.
Quantity / Item Description / Cost / Total Cost
Materials and Supplies / # / Click or tap here to enter text. / $ / $ /
# / Click or tap here to enter text. / $ / $ /
# / Click or tap here to enter text. / $ / $ /
# / Click or tap here to enter text. / $ / $ /
# / Click or tap here to enter text. / $ / $ /
Services / # / Click or tap here to enter text. / $ / $ /
# / Click or tap here to enter text. / $ / $ /
# / Click or tap here to enter text. / $ / $ /
Other / # / Click or tap here to enter text. / $ / $ /
# / Click or tap here to enter text. / $ / $ /
# / Click or tap here to enter text. / $ / $ /
TOTAL COSTS: Click or tap here to enter text.

TOTAL REQUEST: Click or tap here to enter text.

  1. BUDGET JUSTIFICATION

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  1. BIOSKETCH

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NOVEMBER 2016 / 1