Center of Biomedical Research Excellence on

the Molecular Basis of Human Disease.

 

PILOT RESEARCH GRANT APPLICATION

 

I.  BASIC INFORMATION

 

 

A.            TITLE OF RESEARCH PROJECT:

 

 

 

 

B.            DATE OF SUBMITTAL: 

 

 

 

C.            PRINCIPAL INVESTIGATOR:          

 

 

 

D.            ACADEMIC POSITION:                   

 

 

 

 

E.                   DEPARTMENT:

 

 

 

 

 

F.                   DATE OF APPOINTMENT:

 

 

 

 

G.                   FUNDS REQUESTED (Up to $50,000):

 

 

 

 

 

H.                  NAME AND SIGNATURE OF DEPARTMENT CHAIR OR DIVISON CHIEF:

 

 

 

 

________________________________________         _______________    

                         SIGNATURE                                                DATE

 

II. BUDGET

 

A.            PERSONNEL (NO PI SALARY WILL BE PROVIDED)

 

                                                                                PERCENT               SALARY                                               TOTAL

  NAME                                              TITLE                     OF TIME                               REQUESTED         FRINGE             REQUESTED            

 

 

 

 

B.            TRAVEL  

 

 

 

C.                   SUPPLIES (LIST IN CATEGORIES):

 

 

 

 

D.            OTHER (LIST IN CATEGORIES): 

 

 

 

 

SUMMARY BUDGET REQUEST:

Provide the requested dollar amounts in the following format:

(Note the total budget excluding indirect costs cannot exceed $50,000)

               

CATEGORY	AMOUNT
a. PERSONNEL
b. TRAVEL
c. SUPPLIES
d. OTHER
f. TOTAL

Detailed Budget justification

(Justify all expenditures in each category.

Insert additional pages as needed.)

III.             OTHER SUPPORT

NOTE ANYONE WITH AN NIH RO1 TYPE GRANT OR AN NSF RESEARCH GRANT IS INELIGIBLE TO APPLY FOR A COBRE PILOT GRANT.

(If more room is needed, attach additional pages.)

 

 

A.                  Is support for this project currently being sought at the NIH or NSF?                      _____ YES             _  NO

 

 

 

B.                   Is this research activity or related projects currently being supported from other sources? ___YES  _ _ NO

 

 

 

 

C.                   List all other sources of research support including pending applications.  Give complete titles and grant numbers, total funding, yearly funding, and project period.

 

 

Current support:

 

 

 

 

 

 

 

 

 

 

 

 

Pending support:

 

IV.  OTHER

 

A.     Are human subjects involved in this project?                                        _____ YES            _      NO

B.      Are animals involved in this project?                                          _____ YES         ____ NO

               

If yes, attach copy of your  human subjects/animal research committee approval.

 

                                                                                                                                _____ YES            _____ NO

If approval is not attached, give the date of anticipated approval, at which time a copy must be forwarded.

            Note: Approval is required by the time of review.        

 

                                                                                                                ANTICIPATED DATE        _______________

 

 

 

IV.              RESEARCH PROPOSAL

 

1.                  Proposal Abstract:

 

 

 

 

2.         Relationship of the project to Molecular Basis of Human Disease:

 

 

3          Proposal (Limit your proposal to no more than 5 pages excluding references):

 

Overall Aim:

 

 

Specific Aims

 

 

 

Rationale

 

 

 

Experimental Procedures and Methods:

 

 

 

 

 

 

 

 

References:

 

 

ATTACH AN NIH TYPE BIOGRAPHICAL SKETCH