Request for ICTS JIT Core Usage Funding
Submit this document, Current Biosketch, IRB/IACUC approval (if applicable), and any quotes provided
to icts@dom.wustl.edu by the 10th of any month
Please TAB through this document in order to retain formatting. Use additional pages if needed.
Date Submitted:
Principal Investigator (PI):
Phone #:
(ICTS member & faculty status)
Institution/School/Department:
Fellow/Trainee:
(If PI is mentor for project to be
conducted by research trainee)
Relevant Co-Investigator(s)
Name/Institution/Dept:
Project Title:
Regulatory and Core Information:
*IRB Approval #, pending, or N/A
*IACUC Approval #, pending, or N/A
(human subjects)
(vertebrate animals)
ICTS-affiliated Core(s) to be used:
Name of Core Director(s) providing
Confirmation Form(s) and Quote(s):
*NOTE: requests will not be funded until regulatory approvals are obtained (if applicable).
JIT funding will expire one year after awarded.
Budget Details
Complete the table below for the core services you are proposing to utilize for your study, based on the quote you
received from the core. Please include the quote with your submission to the ICTS.
Core Services
# of Services
Billing Rate ($)
Total Project Funding ($)
Required
Total Cost of Core Services Required for Project $
Total ICTS JIT Request $
(Maximum request is $5,000 unless requesting Human Imaging Unit services where max. is $10,000)
Cost of Core Services Not Covered by this ICTS JIT Request $
(see question 2A on following page)
(Add additional lines, if needed, on a separate page.)
PI Signature:
Date:
ICTS Use Only:
Date Received by ICTS: ___________________________
Date Sent to ICTS Review Committee: _______________________
Funding Decision: __________________________________________________________________________________________
(Approved/Disapproved/Other)
Total Approved Funding: $ ________________________
Approved Project Duration: ________________________________
Date Notification sent to PI: _________________________
Date Notification sent to Core: ______________________________
Processed by:
___________
ICTS ID # ______________________________________________
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Updated 4/2015
ICTS JIT Core Usage Funding Request
Reminder:
Cite the NIH CTSA Grant Number UL1 TR000448
when your research was supported by ICTS/CTSA
funds or services.
PI Request Justification (not to exceed 2 pages)
1. Mentor Submitting as Principal Investigator for Research Fellow/Trainee Project
If this project will be conducted by a research fellow/trainee identified on the first page of this application, briefly
describe the circumstance, or note N/A.
2. Funding Overlap
A. What other funding is currently available for this project? If funding exists, explain why additional funding
is needed and provide specifics regarding funding source (i.e. internal, external, agency name, agency #, etc.)
NOTE: If the ICTS JIT requested costs are less than the full project costs, explain the additional funding source for
this project.
B. Have you or any of your collaborators previously received BJHF/ICTS Pilot funding or JIT funding for
this same project?
Yes
No If yes, please explain.
3. Purpose
This program is designed to support investigators in obtaining final data A) for developing a clinical/translational
proposal to be submitted for extramural funding and/or B) leading to a concrete improvement in patient care at
Barnes-Jewish Hospital or St. Louis Children’s Hospital. Depending on your purpose for requesting funds,
describe:
A. How the ICTS subsidized services will help you obtain external funding.
In your answer, include all four of the following: 1) name of PI for external grant submission; 2) funding agency;
3) funding mechanism; and 4) anticipated date of submission.
B. How the ICTS subsidized services will help lead you to a concrete improvement in patient care at BJH
or SLCH.
4. Project Specifics. Please provide:
A. A brief description of the project
B. An explanation of services to be performed and the relation to the project (should clearly match the funding
request shown on the first page of this application)
C. If applicable, address ability/plan to meet recruitment within the 12 month JIT funding period
D. For applications that deal with animal models or in vitro culture systems, there must be included in the text, a
DIRECT or CLEAR LINK to human health or disease. Describe how the project indicates a clear pathway from
expected findings to prevention, diagnosis, or treatment of human disease.
Use a separate page to answer questions 1-4, where needed.
Page 2
Updated 12/2015
ICTS JIT Core Usage Funding Request
Reminder:
Cite the NIH CTSA Grant Number UL1 TR000448
when your research was supported by ICTS/CTSA
funds or services.
ICTS Core Director Confirmation Form
To be completed by the Director of the Core (see list on following page). Use multiple forms if multiple cores are to be used.
Name of Core Director:
Name of ICTS-affiliated Core:
Principal Investigator:
Project Title:
1. Services to be provided by the core:
2. Total Direct Costs of services to be provided:
3. Does your core have the capacity to provide the requested services within a 12-month period?
4. Have you accounted for ICTS subsidized services provided by your core when considering the service
provision and development of pricing for this project? (e.g. 2 hours of services fully subsidized, balance will be
paid from JIT funding)
Yes
No
N/A
Describe:
5. Briefly describe the interaction your core has had with this PI in determining the relevant services required
to conduct the proposed project. Note any other pertinent information regarding this service request.
Core Director Signature:
Date:
Page 3
Updated 12/2015
ICTS JIT Core Usage Funding Request
Reminder:
Cite the NIH CTSA Grant Number UL1 TR000448
when your research was supported by ICTS/CTSA
funds or services.
CORE & CORE DIRECTOR SIGNATURE TABLE
Listed alphabetically below are the research cores that are formally associated with the ICTS JIT Core-Usage
Funding Program. A support verification statement and the signature of the listed Core Director/CoDirector/Associate Director are required on the “ICTS Core Director Confirmation Form”.
Core:
Director(s):
Center for Applied Research Sciences (CARS):
-CARS: Clinical Research Unit (CRU)
Samuel Klein, MD
-CARS: Clinical Trials Unit (CTU)
Samuel Klein, MD
-CARS: Lifestyle Intervention Research Core (LIRC)
Samuel Klein, MD
-CARS: Cardiovascular Imaging and Clinical Research Core Laboratory (CIRCL)
Victor G. Davila-Roman, MD
-CARS: Pediatric Clinical Research Unit (PCRU)
Neil White, MD
Center for Biomedical Informatics (CBMI)
Leslie McIntosh MPH, PhD
Center for Clinical Research Ethics (CCRE)
James DuBois, PhD, DSc
Center for Community Engaged Research (CCER):
-CCER: REACH
Angela L. Brown, MD
-CCER: WU PAARC
Jane Garbutt, MBChB, FRCP
Center for High Performance Computing (CHPC)
Rohit Pappu, PhD
Core Laboratory for Clinical Studies (CLCS)
Richard Ostlund, MD
Genome Institute
Richard K. Wilson, PhD
Genomic Medicine Program (GMP):
-GMP: Clinical Genomics Research Unit (CGRU)
Shashikant Kulkarni, MS, PhD
-GMP: Genome Engineering and iPSC Center (GEiC)
Shondra Miller, PhD
-GMP: Genome Technology Access Center (GTAC)
Richard Head, PhD
-GMP: Human Embryonic Stem Cell Core (hESC)
Mariana Beltcheva, PhD
-GMP: Statistical Genetics Analysis Core (SGAC)
Michael Province, PhD
High-Throughput Screening Center (HTSC)
Maxene Ilagan, PhD
Human Imaging Unit (HIU)
Robert McKinstry, MD, PhD
Recruitment Enhancement Core (REC)
Yi Zhang, JD, RN or Samuel Klein, MD
Regulatory Support Center (RSC)
Yi Zhang, JD, RN or Samuel Klein, MD
Translational Pathology & Biomarker Development (TPBD):
-TPBD: Anatomic and Molecular Pathology Core Lab (AMP)
Erika Crouch, MD, PhD
-TPBD: Human and Mouse Linked Evaluation of Tumors (HAMLET)
Shunqiang Li, PhD
-TPBD: Metabolomics Facility
Daniel S. Ory, MD
-TPBD: Proteomics and Mass Spectrometry (PMSP)
R. Reid Townsend, MD, PhD
-TPBD: Tissue Procurement Core (TPC)
Mark Watson, MD, PhD
-TPBD: Translational Cardiovascular Biobank & Repository (TCBR)
Jeanne Nerbonne, PhD
Translational Research Methods and Analysis Center (TRAC):
-TRAC: Center for Administrative Data Research (CADR)
Margaret Olsen, PhD, MPH
-TRAC: Dissemination and Implementation Research Core (DIRC)
Enola Proctor, PhD
-TRAC: Research Design and Biostatistics (RDBG)
J. Philip Miller
-TRAC: Health Behavior Communication and Outreach Core (HBCOC)
Donna Jeffe, PhD
Women and Infants’ Health Specimen Consortium (WIHSC)
Ann M. Gronowski, PhD
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