CESCG Call 2: Collaborative Research Program
Application Information (Part B)
1. Principal Investigator
Name:
Title:
Institution:
Department:
Address:
Phone:
Email:
Percent Effort on this Project:
Percent Salary Charged to this Subcontract (if applicable):
2. Authorized Organization Official
An AOO is an individual named by the applicant organization who is authorized to act for the
applicant organization and to assume the obligations imposed by the laws, regulations,
requirements, and conditions that apply to applications and contracts.
Name:
Title:
Institution:
Address:
Phone:
Email:
Assurances (SCRO, IRB, IACUC)
If your project requires review and approval for Stem Cell Research (SCRO), Human Subject Use
(IRB) and / or Vertebrate Animal Use (IACUC), you will need to provide evidence of such
approval prior to CRP project funding being issued.
Research Area (check one)
The CESCG will support all competitive genomics research projects that are relevant to the
mission of CIRM, but clinically oriented projects are of particular interest. Can this project be
classified as supporting translational research efforts and/or precision medicine?
( ) Yes
( ) No
3. Budget Justification
CESCG Resources Justification
These funds will be paid by CIRM directly to the CESCG. They will not be distributed to your
institution.
In this section, provide a justification for the CESCG resources requested in the context of the
proposed research. Provide sufficient explanation and detail to enable CESCG and external
reviewers to clearly understand the rationale and reasonableness of types and amounts of
resources requested.
CESCG Resources (listed on the CESCG CRP website
http://med.stanford.edu/cescg/CRPs/): List all CESCG resources (types and number) you
request for your project, the direct costs for each service, and justify their use.
CESCG Bioinformatics Cost For most Regular CRP projects with standard analytical
requirements bioinformatics resources will be available as needed and do not need to be
budgeted separately. If requested, the cost of this item will be determined through consultation
with CESCG (contact information at http://med.stanford.edu/cescg/CRPs/). List the negotiated
amount (direct costs) and justify.
Additional funds
In addition to the CESCG resources, I request funds for activities in my laboratory.
(
(
) Yes
) No
If No, please sign #9.,Certification
If Yes, please fill out #4-9
4. Award Mailing Address
Attention:
Department:
Address:
5. Budget Justification, continued
Justification of Collaborator Budget
These funds will be disbursed to your organization through a subcontract from a CESCG partner
institution, Stanford University or The Salk Institute for Biological Studies. Collaborator budgets
are limited to 25% of total project direct costs unless a letter from CIRM indicating prior approval
for exceeding this limit is provided with the application.
In this section, provide a justification and describe the basis for the costs in the proposed
Collaborator Budget, i.e. for the funds requested for activities in the applicant’s laboratory. Please
justify all costs in the context of the proposed activities. Provide sufficient explanation and detail
to enable CESCG and external reviewers to clearly understand the rationale and reasonableness
of amounts proposed in all budget categories (e.g., Personnel, Supplies).
Key Personnel
Sub-subcontracts / Consultants
Justify key personnel needs in relation to the activities proposed. ANY INDIVIDUAL OR
ORGANIZATION REFERENCED MUST HAVE BEEN LISTED IN THE KEY PERSONNEL
SECTION of Part A of your application. Personnel costs are limited to $40,000 per year.
A consultant is an individual who provides professional advice or research services related to the
proposed project for a fee. Aside from small consulting contracts, fund recipients may not use
CIRM funds to contract for research to be performed outside of California. Consulting contracts
for out-of-state research are limited to $15,000 per year for a single contract, and $25,000 per
year in aggregate. Any amount exceeding these limits may not be allowed should the application
be approved for funding.
Additional Unnamed Personnel: Describe the specific roles, activities, and number of
personnel to be supported by these funds. DO NOT IDENTIFY ANY OF THESE INDIVIDUALS
BY NAME.
Supplies: Describe proposed expenditures for all supplies in relation to activities proposed.
Travel and Equipment : These costs are not allowed under CESCG Call 2.
6. CIRM Major Facility Certification
This section should be completed by your Institutional Official.
For institutions that have a CIRM Major Facility, this certification is required in order to determine
the level of facilities cost reimbursement that will apply to this award, if funded. (Use your
institution's standard facilities rates in the application. Any necessary adjustment will be made
later.)
Does your organization have a CIRM Major Facility?
( ) Yes
( ) No
If you answered 'Yes' above, please check the following that apply:
[ ] The Principal Investigator is not associated with the research program identified in Part 1,
subpart B of the Applicant Institution's Major Facilities Grant Award application that was proposed
to be located in the CIRM-funded Major Facility
[ ] The Applicant Institution did not identify the Principal Investigator in the Applicant Institution's
space plan submitted to CIRM at the time of completion of construction as a researcher who
would be located in the CIRM-funded Major Facility
[ ] The institution has allocated space, outside the Major Facility, in which the PI will conduct the
proposed research, and the PI will not make use of the Major Facility, aside from occasional use
of shared specialized resource
7. Biosafety Certification
[ ] I hereby certify that organizational approval for any proposed use of biohazardous materials,
radioisotopes, and/or controlled substances is current and will remain in effect for the proposed
project period. I also certify that key personnel will obtain formal training and appropriate
authorization for the use of biohazardous materials, radioisotopes, and/or controlled substances
prior to their commencing work on the proposed project or activity.
8. Related Business Entities Disclosure
If your Application seeks funding for a for-profit organization, California conflict-of-interest laws
require disclosure of business entities that are related to that "Funded Company". Disclosure is
required for any company that would receive funding as the applicant organization, as a subsubcontractor, or as the employer of a co-investigator, sub-subcontractor or consultant.
For-profit organization means: a sole proprietorship, partnership, limited liability company,
corporation, or other legal entity
Related Business Entity means:
1. a for-profit organization that owns 50% or more of the Funded Company's voting shares;
2. a for-profit organization subsidiary in which the Funded Company owns 50% or more of
the voting shares;
3. a for-profit organization that is under the same management and control as the Funded
Company or with which it shares a controlling owner.
The Application does propose funding for one or more for-profit organizations identified by name.
( ) Yes
( ) No
If yes, please provide the following information; copy and paste the below entries for more funded
companies and RBEs as needed.
Funded company name:
List all Related Business Entities (RBE) for the Funded Company
RBE name:
9. Certification
I certify that the statements herein are true and complete
Signature of PI:
I certify that the statements herein are true and complete
Signature of AOO: