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)
TEL:
E-MAIL ADDRESS:
FAX:
INSTITUTION
Name
BUDGET SUMMARY
DATES OF PROPOSED PERIOD OF
SUPPORT (month, day, year—MM/DD/YY)
From
Through
COSTS REQUESTED FOR INITIAL
BUDGET PERIOD (Year 1)
COSTS REQUESTED FOR PROPOSED
PERIOD OF SUPPORT
Direct Costs ($)
Direct Costs ($)
OTHER
HUMAN SUBJECTS RESEARCH
No
Yes
If “Yes”, Human Subjects Assurance No.
Smooth Muscle Plasticity COBRE Phase III Pilot Grant Application
VERTEBRATE ANIMALS
If “Yes,” IACUC Approval Date
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No
Yes
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)
Smooth Muscle Plasticity COBRE Phase III Pilot Grant Application
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Principal Investigator (Last, First, Middle):
PROJECT PERSONNEL. List all personnel in alphabetical order, last name first.
Name
Organization
OTHER SIGNIFICANT CONTRIBUTORS
Name
Role on Project
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:
http://stemcells.nih.gov/registry/index.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
Smooth Muscle Plasticity COBRE Phase III Pilot Grant Application
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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 ..................................................................................................................................................
Description, Project/Performance Sites, Senior/Key Personnel, Other Significant Contributors,
and Human Embryonic Stem Cells .........................................................................................................
Table of Contents .....................................................................................................................................
Detailed Budget for Proposed Period of Support .........................................................................................
Biographical Sketch – Principal Investigator (Not to exceed four pages) ..............................................
Other Biographical Sketches (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) ...................................................................................................................
Smooth Muscle Plasticity COBRE Phase III Pilot Grant Application
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1
2
4
Principal Investigator (Last, First, Middle):
FROM
THROUGH
DETAILED BUDGET FOR PROPOSED PERIOD OF SUPPORT
DIRECT COSTS ONLY
(follow standard R01 application instructions)
PERSONNEL (Applicant organization only)
ROLE ON
PROJECT
NAME
Months Devoted to Project
Cal.
Mnths
Acad.
Mnths
Summer INST.BASE
Mnths
SALARY
DOLLAR AMOUNT REQUESTED (omit cents)
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
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$
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.
Smooth Muscle Plasticity COBRE Phase III Pilot Grant Application
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Principal Investigator (Last, First, Middle):
Research Plan (not to exceed 5 pages)
Smooth Muscle Plasticity COBRE Phase III Pilot Grant Application
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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)
SOCIAL SECURITY NUMBER
(last 4 digits only)
SEX/GENDER
XXX-XX-
Female
Male
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
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