CENTER FOR THE STUDY OF INFLAMMATORY BOWEL DISEASE
PILOT/FEASIBILITY STUDY GRANTS
The completed application must include the following:
1.
Research Proposal Coversheet (“Application Part 2”), signed by either the Chief of Service/Department or Unit
Chief and applicant as Principal Investigator.
2.
Abstract of proposed project - limited to 200 words (form attached).
3.
Budget (NIH Format) not to exceed $35,000 (direct costs) with full justification for each category requested. No
funds will be provided for equipment or Facilities and Administrative Costs. Provide background/experience of key
personnel and explain their role in the proposed project. The award period will be from January 1, 2016 through
December 31, 2016.
4.
The applicant’s biosketch (NIH Format, limited to five pages – see guidelines at
http://grants.nih.gov/grants/guide/notice-files/NOT-OD-15-032.html).
5.
The applicant’s Other Support (NIH Format). Be sure to include the relationship to the PFS application and
scientific overlap, if any.
6.
Description of the proposed project (maximum of five single-spaced pages, including references). Be specific
about experimental procedures. Detail previous work and/or data pertinent to the proposed project. The
description should include a statement of plans for the project beyond the pilot phase. The relevance to IBD
research should also be clearly stated. Please indicate the location(s) in which this work will be conducted.
7.
Letter of support from professional supervisor (Department Chair, Chief of Service or Unit Chief).
8.
A copy of the institutional Human Study and/or Animal Study approval notice, as appropriate.
Applications should be single-sided. Appendices and publications should not be included.
Recipients of PFS grants will be expected to participate in the activities of the CSIBD, including presentation of the
progress of their PFS-supported studies during the course of the grant period. Recipients must also prepare a final,
written report at the end of the support period.
Please note: Support from the CSIBD must be acknowledged on all resulting manuscripts.
Completed applications should be submitted to the CSIBD Administrative Office, Massachusetts General
Hospital, 55 Fruit Street, Jackson Building, 7th Floor, Boston, MA 02114 by 4:00pm of the deadline date. For
further information, contact Lindsay Ware at 617-643-2421 or lware@partners.org.
Deadline: OCTOBER 13th, 2015
Program Director/Principal Investigator (Last, First, Middle):
PROJECT SUMMARY (See instructions):
RELEVANCE (See instructions):
PROJECT/PERFORMANCE SITE(S) (if additional space is needed, use Project/Performance Site Format Page)
Project/Performance Site Primary Location
Organizational Name:
DUNS:
Street 1:
Street 2:
City:
Province:
County:
State:
Country:
Zip/Postal Code:
Project/Performance Site Congressional Districts:
Additional Project/Performance Site Location
Organizational Name:
DUNS:
Street 1:
Street 2:
City:
Province:
County:
Country:
State:
Zip/Postal Code:
Project/Performance Site Congressional Districts:
PHS 398 (Rev. 6/09)
Page _
Form Page 2
Program Director/Principal Investigator (Last, First, Middle):
SENIOR/KEY PERSONNEL. See instructions. Use continuation pages as needed to provide the required information in the format shown below.
Start with Program Director(s)/Principal Investigator(s). List all other senior/key personnel in alphabetical order, last name first.
Name
eRA Commons User Name
OTHER SIGNIFICANT CONTRIBUTORS
Name
Organization
Organization
Role on Project
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:
http://stemcells.nih.gov/research/registry/eligibilityCriteria.asp. 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
PHS 398 (Rev. 6/09)
Page _
Form Page 2-continued
Number the following pages consecutively throughout
the application. Do not use suffixes such as 4a, 4b.
Program Director/Principal Investigator (Last, First, Middle):
DETAILED BUDGET FOR INITIAL
BUDGET PERIOD
List PERSONNEL (Applicant organization only)
DIRECT
Use Cal, Acad, or Summer
to Enter Months COSTS
Devoted to ProjectONLY
FROM
THROUGH
Enter Dollar Amounts Requested (omit cents) for Salary Requested and Fringe Benefits
ROLE ON
PROJECT
NAME
Cal.
Mnths
Acad.
Mnths
Summer
Mnths
INST.BASE
SALARY
SALARY
REQUESTED
FRINGE
BENEFITS
TOTAL
PD/PI
SUBTOTALS
CONSULTANT COSTS
EQUIPMENT (Itemize)
SUPPLIES (Itemize by category)
TRAVEL
INPATIENT CARE COSTS
OUTPATIENT CARE COSTS
ALTERATIONS AND RENOVATIONS (Itemize by category)
OTHER EXPENSES (Itemize by category)
CONSORTIUM/CONTRACTUAL COSTS
DIRECT COSTS
SUBTOTAL DIRECT COSTS FOR INITIAL BUDGET PERIOD (Item 7a, Face Page)
FACILITIES AND ADMINISTRATIVE COSTS
CONSORTIUM/CONTRACTUAL COSTS
TOTAL DIRECT COSTS FOR INITIAL BUDGET PERIOD
PHS 398 (Rev. 6/09)
$
Page _
$
Form Page 4
BIOGRAPHICAL SKETCH
Provide the following information for the Senior/key personnel and other significant contributors.
Follow this format for each person. DO NOT EXCEED FIVE PAGES.
NAME:
eRA COMMONS USER NAME (credential, e.g., agency login):
POSITION TITLE:
EDUCATION/TRAINING (Begin with baccalaureate or other initial professional education, such as nursing,
include postdoctoral training and residency training if applicable. Add/delete rows as necessary.)
INSTITUTION AND LOCATION
DEGREE
(if
applicable)
Completion
Date
MM/YYYY
FIELD OF STUDY
NOTE: The Biographical Sketch may not exceed five pages. Follow the formats and instructions below.
A.
Personal Statement
Briefly describe why you are well-suited for your role in the project described in this application. The relevant
factors may include aspects of your training; your previous experimental work on this specific topic or related
topics; your technical expertise; your collaborators or scientific environment; and your past performance in this
or related fields (you may mention specific contributions to science that are not included in Section C). Also,
you may identify up to four peer reviewed publications that specifically highlight your experience and
qualifications for this project. If you wish to explain impediments to your past productivity, you may include a
description of factors such as family care responsibilities, illness, disability, and active duty military service.
B.
Positions and Honors
List in chronological order previous positions, concluding with the present position. List any honors. Include
present membership on any Federal Government public advisory committee.
C.
Contribution to Science
Briefly describe up to five of your most significant contributions to science. For each contribution, indicate the
historical background that frames the scientific problem; the central finding(s); the influence of the finding(s) on
the progress of science or the application of those finding(s) to health or technology; and your specific role in
the described work. For each of these contributions, reference up to four peer-reviewed publications or other
non-publication research products (can include audio or video products; patents; data and research materials;
databases; educational aids or curricula; instruments or equipment; models; protocols; and software or
netware) that are relevant to the described contribution. The description of each contribution should be no
longer than one half page including figures and citations. Also provide a URL to a full list of your published
work as found in a publicly available digital database such as SciENcv or My Bibliography, which are
maintained by the US National Library of Medicine.
D.
Research Support
List both selected ongoing and completed research projects for the past three years (Federal or non-Federallysupported). Begin with the projects that are most relevant to the research proposed in the application. Briefly
PHS 398/2590 (Rev. 06/09)
Page
Continuation Format Page
indicate the overall goals of the projects and responsibilities of the key person identified on the Biographical
Sketch. Do not include number of person months or direct costs.
PHS 398/2590 (Rev. 06/09)
Page
Continuation Format Page
PHS 398/2590 OTHER SUPPORT
Provide active support for all key personnel. Other Support includes all financial resources, whether Federal, non-Federal, commercial or
institutional, available in direct support of an individual's research endeavors, including but not limited to research grants, cooperative
agreements, contracts, and/or institutional awards. Training awards, prizes, or gifts do not need to be included.
There is no "form page" for other support. Information on other support should be provided in the format shown below, using continuation pages as
necessary. Include the principal investigator's name at the top and number consecutively with the rest of the application. The sample below is
intended to provide guidance regarding the type and extent of information requested.
For instructions and information pertaining to the use of and policy for other support, see Other Support in the PHS 398 Part III, Policies, Assurances,
Definitions, and Other Information.
Note effort devoted to projects must now be measured using person months. Indicate calendar, academic, and/or summer months associated with each
project.
Format
NAME OF INDIVIDUAL
ACTIVE/PENDING
Project Number (Principal Investigator)
Source
Title of Project (or Subproject)
The major goals of this project are…
OVERLAP (summarized for each individual)
Dates of Approved/Proposed Project
Annual Direct Costs
Person Months
(Cal/Academic/
Summer)