PRINCIPAL INVESTIGATOR (LAST, FIRST, MIDDLE):
PEOPLE AND PLACES TEMPLATE
Refer to the PCORI Application Guidelines, available in the PCORI Funding Center, for additional guidance.
PROFESSIONAL PROFILE/BIOSKETCH
Provide the following information for the Principal Investigator, key personnel, and other significant contributors. Alternatively, NIH biosketches may be used. Patient
and stakeholder partners serving in these roles may choose to complete the “Patient and Stakeholder Partner Profile/Biosketch” form that follows in lieu of this
form. Do not exceed four pages per person.
NAME (Last, First):
EDUCATION/TRAINING
List all post-secondary education and training, including institution, degree conferred (if any), and year. Include
internships, residencies, and fellowships, and give beginning and end dates for each.
INSTITUTION AND LOCATION
DEGREE
(if applicable)
DATE AWARDED
(if applicable)
FIELD OF STUDY
PROFESSIONAL STATEMENT
Briefly describe why your experience and qualifications make you particularly well suited for your role in the proposed
project. Limit is 250 words.
EMPLOYMENT AND POSITIONS HELD
List all professional positions held since completion of education. Add lines if necessary.
INSTITUTION AND LOCATION
People and Places Template
RESPONSIBILITIES
DATE
1
PRINCIPAL INVESTIGATOR (LAST, FIRST, MIDDLE):
HONORS
List any honors. Include present membership or leadership in relevant organizations or advisory groups.
SELECTED PEER-REVIEWED PUBLICATIONS
Please limit the list of selected peer-reviewed publications or manuscripts in press to no more than 15 of those most
relevant to the research being proposed.
OTHER SELECTED PUBLICATIONS
This can include op-ed pieces, newsletters, blogs, and non-peer-reviewed reports. Please list no more than 10 of those
most relevant to the research being proposed.
PUBLIC SPEAKING OR PRESENTATIONS
This can include testimony, scientific talks, or presentations. Please limit to presentations given in the past two years.
RESEARCH SUPPORT
List both selected ongoing and completed research projects for the past three years. Begin with the projects tha t are
most relevant to the research being proposed in the PCORI application. Briefly indicate the overall goals of the
projects.
INSTITUTION AND LOCATION
People and Places Template
RESPONSIBILITIES
DATE
2
PRINCIPAL INVESTIGATOR (LAST, FIRST, MIDDLE):
OTHER
Please include any additional relevant information to help us assess the qualifications of the key personnel for the
project.
People and Places Template
3
PRINCIPAL INVESTIGATOR (LAST, FIRST, MIDDLE):
PATIENT AND STAKEHOLDER PARTNER PROFILE/BIOSKETCH
Provide the following information for patient and stakeholder partners serving as key personnel or other significant contributors.
Do not exceed four pages per person.
NAME (Last, First):
PROFESSIONAL/PERSONAL STATEMENT
Briefly describe why your experience and qualifications make you particularly well suited for your role in the proposed
project. Limit is 250 words.
EXPERIENCE, LEADERSHIP AND ENGAGEMENT
Patient and stakeholder partners are invited to list personal and professional experience relevant to the research topic,
including participation with community and voluntary organizations, and membership or leadership in relevant
organizations and advisory groups.
ORGANIZATION (If Applicable) AND LOCATION
ROLE/RESPONSIBILITIES
DATE
ENGAGEMENT IN RESEARCH
Patient and stakeholders are invited to outline past engagement in research, including participation in an advisory
capacity, publications authored or co-authored, and presentations made. Briefly indicate the role played by the
patient and stakeholder partner.
INSTITUTION/ORGANIZATION/PROJECT AND LOCATION
People and Places Template
ROLE/PUBLICATIONS/PRESENTATIONS
DATE
4
PRINCIPAL INVESTIGATOR (LAST, FIRST, MIDDLE):
OTHER
Please include any additional relevant information to help us better understand the experience and expertise of
patient and stakeholder partners for the project.
People and Places Template
5
PRINCIPAL INVESTIGATOR (LAST, FIRST, MIDDLE):
PROJECT/PERFORMANCE SITE(S) AND RESOURCES
For detailed instructions, refer to the Application Guidelines. Do not exceed 15 pages. Use continuation pages and add additional facilities as needed.
PRIMARY RESEARCH FACILITY
Name:
Street address:
City, county, state, and zip code:
Provide a description of the facility, including capacities, capabilities, and extent of availability to the project.
FACILITY 2:
Name:
Street address:
City, county, state, and zip code:
Provide a description of the facility, including capacities, capabilities, relative proximity to other project facilities,
and extent of availability to the project.
People and Places Template
6