Competitive Medical Research Fund (CMRF)

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					UPMC Health System Competitive Medical Research Fund (CMRF)
University of Pittsburgh Office of Research, Health Sciences

 Application Form for Research Grant Support                                                                      FORM MUST BE TYPEWRITTEN
 Face Page (Page 1)

Principal Investigator:________________________________                                                              Duration
                                        (Last Name, First Name, Degree(s))              Funding Category             (check only one)     Funding
                                                                                                                                          A maximum total award of $25K
Co-Principal Investigator:______________________________                                Bridge Funding               1 Yr
                                                                                                                                          must be expended within a one-year
(Collaborative Proposal only)        (Last Name, First Name, Degree(s))                                                                   period.

Rank (check only one)           Research Assistant                Assistant Professor   New Investigator             1 Yr       2 Yrs     A maximum total award of $25K
                                                                                                                                          must be expended within a two-year
                                Professor                                                                                                 period.

                                Research Associate                Associate Professor   Collaborative Proposal       1 Yr       2 Yrs     A maximum total award of $25K
                                                                                                                                          must be expended within a two-year
                                 Professor                                                                                                period.

                                Research Professor                Full Professor
                                                                                                                                              Year 1            Year 2
                                           Senior Research Scientist                    Total Cost for Project ___________________
                                        (collaborative proposal only)                                                 (All Categories)

                    Degree ________ Year Awarded _________
                    Degree ________ Year Awarded _________

Primary Depart and Division:___________________________
                                                                                        Have you previously applied for funding from the CMRF?             Yes         No
Co-PI Primary Depart and Division:_________________________                               If “Yes,” when? _______________
(Collaborative Proposal only)

Telephone:______________________ Fax:________________________                           Is this a revised CMRF application?                                Yes         No


E-mail:______________________________________________________                           Have you previously received funding from the CMRF?                Yes         No

Mailing Address:______________________________________________
                                                                                                                   Research Compliance
___________________________________________________________                             Does this research use:

___________________________________________________________                              Recombinant DNA?                                                 Yes         No
                                                                                          If “Yes,” IBC approval will be required
                                                                                          before an award can be made.
                                                                                         Human Subjects?                                                  Yes         No
Title of Investigation:_________________________________________                          If “Yes,” IRB approval will be required
                                                                                          before an award can be made.
___________________________________________________________                                                                                               Yes         No
                                                                                         Vertebrate Animals?
___________________________________________________________                               If yes, IACUC approval will be required
                                                                                          before an award can be made.
                                                                                                                                                          Yes         No
                                                                                         Recently Deceased Humans?
Location/Facility for Completion of Project:                                              If yes, CORID approval will be required
                                                                                          before an award can be made.
___________________________________________________________                               Do not submit IBC, IRB, IACUC, or CORID protocols or
                                                                                                 approval letters with application materials.


 If an award is made, the recipient will abide by all guidelines established by the Institutional Review Board (IRB), Institutional Animal Care and
 Use Committee (IACUC), the Committee for Oversight of Research Involving the Dead (CORID), and/or the Institutional Biosafety Committee
 (IBC) of the University of Pittsburgh and any other relevant regulatory approvals, in addition to any cooperative agreements between the
 University IRB/IACUC/IBC and other institutions.

_______________________________________________________________________________________                                     ________________________
Signature of Principal Investigator                                                                                         Date

______________________________________________________________________                                                      ___________________
Signature of Principal Investigator’s Supervisor                                                                                   Date

_______________________________________________________________________                                                     ___________________
Print or type name of Principal Investigator’s Supervisor                                                                          Date

 Submit proposals to:                                                Selena A. Crawford, CMRF Coordinator
                                                                              Scaife Hall, Suite 401
                                                                               3550 Terrace Street
                                                                              Pittsburgh, PA 15261
                                                                            412.648.2233 (telephone)

				
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posted:9/17/2012
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