The INDU Foundation and AIDS International
Training Program (AITRP)Pilot Grant
DUE DATE: MONDAY, JUNE 22, 2009
INVESTIGATOR’S
PRIMARY
INSTITUTION
1. PRINCIPAL INVESTIGATOR/PROGRAM DIRECTOR
PSYCHOSOCIAL RESEARCH
1a. NAME (Last, first, middle)
1g. MAILING ADDRESS (Street, city, state, zip code)
No
Yes
1b. POSITION TITLE / ACADEMIC RANK
1c. DEPARTMENT, SERVICE, LABORATORY, OR EQUIVALENT
1d. MAJOR SUBDIVISION
1e. TELEPHONE (Area code, number and extension) AND E-MAIL
TEL:
E-MAIL:
2. TITLE OF PROJECT
3. HUMAN SUBJECTS 3b. Human Subjects Assurance No.
RESEARCH
No
Yes
3c. Clinical Trial
No
Yes
4. VERTEBRATE ANIMALS
3d. NIH-defined Phase III
Clinical Trial
No
Yes
4a. If “Yes,” IACUC approval
Date
No
Yes
4b. Animal welfare assurance no.
3a. Research Exempt
If “Yes,” Exemption No.
No
Yes
5. DATES OF PROPOSED PERIOD OF
SUPPORT (month, day, year—MM/DD/YY)
From
6. COSTS REQUESTED FOR PROPOSED
BUDGET PERIOD (Indirect Costs not Allowed)
7. WILL THE PROJECT INCLUDE SUBAWARDS OR SUB-CONTRACTS ?
Through
YES
NO
Direct Costs ($):
8. APPLICANT VERIFICATION OF ELIGIBILITY
10. PLEASE CHECK ALL SHAREDRESOURCES TO BE
(Applicants must be within six years of their first independent research or
faculty appointment and may not have competitive national funding at the start
UTILIZED IN THIS PROJECT:
of the proposed IRG allocation)
ANALYTICAL MICROSCOPY
PI NAME:
BIOSTATISTICS
CELL THERAPIES
_____________________________________________ _______________
SIGNATURE
DATE
CLINICAL TRIALS LAB
DATA MANAGEMENT (CRSS)
TISSUE
CHAIR/PROGRAM LEADER NAME:
_____________________________________________ _______________
SIGNATURE
DATE
9. ADMINISTRATIVE OFFICIAL TO BE NOTIFIED IF AWARD IS MADE
Name:
Title:
Tel:
E-mail:
FLOW CYTOMETRY
HIGH THROUGHPUT SCREENING & CHEMISTRY
BIOMEDICAL INFORMATICS
MICROARRAY
MOLECULAR BIOLOGY
MOUSE MODELS
PROTEOMICS
PROTOCOL REVIEW & MONITORING SYSTEM
STRUCTURAL BIOLOGY
SURVEY METHODS
This is the
first,
second,
submission of this proposal
third (final)
Face Page
Principal Investigator: [Click here and type last name, first name]
NOTE: All BLUE text throughout this application is instructions for the template or
applicant and can be deleted prior to submission.
Specific Application Instructions

Use English, avoid jargon and spell out all abbreviations.

Applicants must use the templates provided.

Font size must be 11 or 12 point black font (e.g., Arial or Times New Roman).

Documents should be single-spaced with all text visible and within the .5 margins (all sides).

The Principal Investigator’s name should be shown in the header of all application pages.

All graphs, diagrams, tables, and charts presented in black ink. Do not include photographs, oversized
documents, or materials that cannot be photocopied into the body of the application.

Observe a 5-page limit for the section “Description of Research Proposed”.
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2
Principal Investigator: [Click here and type last name, first name]
APPLICATION FOR A PILOT PROJECT GRANT
BIOGRAPHICAL INFORMATION
PI First Name, Last name, Degree(s)
Academic Rank
Institution/University Department
School
Year last degree conferred:
Year of first independent position:
Education
Degree/year conferred
Institution/Location
Field of study
Training
Title
Pilot Research Grant
Mentor (If Applicable)
Institution/Location
3
Dates
Principal Investigator: [Click here and type last name, first name]
PI First Name, Last name,
Degree(s)
Appointments
Title
Institution/Location
Dates
Other Research Support
(Sponsor, Project Title, Project Number, PI, Project Dates, Your Effort, Annual Direct Costs, Brief Description of Major Goals)
For the PI and any co-investigators, please list their: (1) current active support; (2) applications and proposals pending review of
funding; and (3) applications and proposals planned or being prepared for submission. Include all Federal, non-Federal, and
institutional research, training, and other grant, contract, and fellowship support at the applicant organization and elsewhere. If effort is
part of a larger project, identify the PI/program director and provide the data for both the parent project and the sub-project. All
pharmaceutical research projects are to be included. If none, state "none".
Publications (use continuation page if necessary)
Continued on next page
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Principal Investigator: [Click here and type last name, first name]
PROJECT TITLE:
PROGRESS REPORT (for competing renewals only; not to exceed one page).
DESCRIPTION OF RESEARCH PROPOSED (5 pages maximum – use continuation pages as necessary)
Sections A-E of the Research Plan should answer these questions:
(1) What do you intend to do?
(2) Why is the work important?
(3) What has already been done?
(4) How are you going to do the work?
(5) What are future funding plans for this project?
A. Specific Aims (1/2 page or less)
State the broad, long-term objectives and describe concisely and realistically what the specific research described in this application
is intended to accomplish along with the hypothesis (or hypotheses) to be tested.
B. Background and Significance (1 page or less)
Describe the background of the research proposed. Critically evaluate existing knowledge and identify specific gaps that the project
intends to fill. Briefly state your research’s importance by relating the specific aims to the broad, long-term objectives.
C. Preliminary Studies (1 page or less)
Describe the PI's preliminary studies pertinent to the research proposed and/or any other information that will help to establish the
experience and the competence of the investigator to pursue the proposed project.
D. Experimental Design & Methods (2 pages)
Outline the experimental design and procedures proposed to accomplish the specific aims of the project. Include the means by which
the data will be collected, analyzed, and interpreted. Describe any new methodology and its advantage over existing methodologies.
Discuss the potential difficulties and limitations of the proposed procedures and alternative approaches to achieve the aims. Provide
a tentative sequence or timetable for the investigation. Highlight any procedures, situations, or materials that may be hazardous to
personnel and the precautions to be exercised.
E. Future Plans (1/2 page or less)
Identify how these funds will provide a foundation for your research work and the potential future sources of funding. For example, if
the project submitted is the initial piece of a larger project, describe how this project will relate to the overall research goal and
provide a timetable for such further applications.
F. Human Subjects
If your project will involve human subjects, you must indicate this on the Proposal Face Page. If you have designated no exemptions
from the regulations, you must succinctly address the following six points:
1. Provide a detailed description of the proposed involvement of human subjects in the work previously outlined in the experimental
design and methods section. Describe the characteristics of the subject population, including their anticipated number, age,
ranges, sex, ethnic background, and health status. Identify the criteria for inclusion or exclusion. Explain the rationale for the
involvement of special classes of subjects, if any, such as fetuses, pregnant women, children, human in vitro fertilization, prisoners
or other institutionalized individuals, or others who are likely to be vulnerable.
2. Identify the sources of research material obtained from individually identifiable living human subjects in the form of specimens,
records, or data. Indicate whether the material or data will be obtained specifically for research purposes or whether use will be
made of existing specimens, records, or data.
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Principal Investigator: [Click here and type last name, first name]
3. Describe plans for the recruitment of subjects and the consent procedures to be followed, including the circumstances under which
the consent will be sought and obtained, who will seek it, the nature of the information to be provided to prospective subjects, and
the method of documenting consent.
4. Describe potential risks -- physical, psychological, social, legal, or other -- and assess their likelihood and seriousness. Where
appropriate, describe alternative treatments and procedures that might be advantageous to the subjects.
5. Describe the procedures for protecting against or minimizing any potential risks, including risks to confidentiality, and assess their
likely effectiveness. Where appropriate, discuss provisions for ensuring necessary medical or professional intervention in the event
of adverse effects to the subjects. Also, where appropriate, describe the provisions for monitoring the data collected to ensure the
safety of subjects.
6. Discuss why the risks to subjects are reasonable in relation to the anticipated benefits to subjects and in relation to the importance
of the knowledge that may reasonably be expected to result.
If a test article (investigational new drug, device, or biologic) is involved, name the test article, the sponsor, and state whether the 30day interval has elapsed or has been waived and/or whether use of the test article has been withheld or restricted by the Food and
Drug Administration.
G. Women & Minorities
Briefly describe how women and minorities will be included in any human subject populations.
H. Vertebrate Animals
If your project will involve vertebrate animals, you must indicate this on the Proposal Submission Form and succinctly address the
following five points.
1. Provided a detailed description of the proposed use of the animals in the work previously outlined in the experimental design and
methods section. Identify the species, strains, ages, sex, and numbers of animals to be used in the proposed work.
2. Justify the use of animals, the choice of species, and the numbers used. If animals are in short supply, costly, or to be used in
large numbers, provide an additional rationale for their selection and numbers.
3. Provide information on the veterinary care of the animals involved.
4. Describe the procedures for ensuring that discomfort, distress, pain, and injury will be limited to that which is unavoidable in the
conduct of scientifically sound research. Describe the use of analgesic, anesthetic, and tranquilizing drugs and/or comfortable
restraining devices where appropriate to minimize discomfort, distress, pain and injury.
5. Describe any euthanasia method to be used and the reasons for its selection. State whether this method is consistent with the
recommendations of the Panel on Euthanasia of the American Veterinary Association. If not, present a justification for not
following the recommendations.
I. Consultants/Collaborators (if any)
J. Consultants/Contractual Arrangements (if any)
K. Literature Cited
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Principal Investigator: [Click here and type last name, first name]
TOTAL AMOUNT REQUESTED*: Rs
PROJECT PERIOD:
*Maximum request Rs 50,000 for 12 months
PROPOSED BUDGET ITEMS
Common Research Expenses
Allowable
Unallowable
 Research supplies and animal maintenance
 Secretarial/administrative salaries
 Technical assistance
 Tuition
 Domestic travel when necessary to carry out the proposed
 Foreign travel (special consideration given for attendance at
Research program
scientific meetings held in Canada)
 Publication costs, including reprints
 Books and periodicals
 Shared resources costs
 Membership dues
 Special fees (pathology, photography, etc.)
 Office and laboratory furniture
 Stipends for graduate students and postdoctoral assistants if
 Office equipment and supplies
their role is to promote and sustain the project presented by the
 Rental of office or laboratory space
junior faculty member
 Recruiting and relocation expenses
 Equipment costing less than $2,000. (Special justification is
 Non-medical services to patients
necessary for items exceeding this amount)
 Per-diem charges for hospital beds
 Registration fees at scientific meetings
 Construction, renovation, or maintenance of buildings/laboratories
Salaries for the Principal Investigator and administrative support are not appropriate budget items. Salaries for support personnel (i.e.,
dishwashers, animal caretakers, histopathology technicians, research technicians or associates, and in some instances data management
personnel) may be requested. Whether or not salaries are requested, list the names and roles of all personnel who will be involved in the
project during the 12-month budget period.
NOTE: Double-click on the budget below to enter data. Be aware that some cells contain formulas. Be sure to scroll to the top of the
spreadsheet, then click outside the budget to exit.
DETAILED BUDGET - DIRECT COSTS ONLY
EFFORT ON
PROJECT
PERSONNEL (Applicant organization only)
NAME
ROLE ON PROJECT INST. BASE
% FTE
FROM:
THROUGH:
7/1/2008
6/30/2009
DOLLAR AMOUNT REQUESTED
(omit paise)
SALARY
REQUESTED
PI
FRINGE
BENEFITS
TOTALS
Not Allowable
-
SUBTOTALS
EQUIPMENT (Itemize)
List separately each item of equipment with a unit acquisition cost less than Rs2,000 and provide a detailed
justification. Note: Requests for equipment require special approval from the Review Committee and
generally are not appropriate for this small grant program.
SUPPLIES (Itemize by category)
Itemize supplies in separate categories such as glassware, chemicals, radioisotopes, etc. If animals are
-
-
involved, state how many are to be used, the unit purchase cost, and the per unit cost of care.
TRAVEL
List details of domestic research-related travel
OTHER EXPENSES (Itemize by category)
Any items not previously listed. For example: animal maintenance, publication costs, shared
-
resources costs, etc.
-
TOTAL DIRECT COSTS FOR PRPOSED PROJECT PERIOD
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-
Principal Investigator: [Click here and type last name, first name]
BUDGET JUSTIFICATION:
Describe the specific functions of the personnel, consultants, and collaborators. Briefly explain and justify items requested in B-D. This
section is critical to the evaluation process. Any item not sufficiently justified may be cut from the project budget.
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Principal Investigator: [Click here and type last name, first name]
CONTINUATION PAGE
(Copy as needed)
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