Non-Human Subjects Application by 13fEYwS

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									   Nova Southeastern University
    Health Professions Division
       Non-Human Subjects
           Application



College:__________________________



Department:______________________
Version 6.0                                                                                  Nova Southeastern University



                                            Background/TOC
If you are NOT using human subjects in your research you must use these forms. The HPD
Research Committee requires a complete research proposal or plan. For directions to complete
this form please download INSTRUCTIONS FOR NON-HUMAN SUBJECTS
APPLICATION. Complete the application and submit to the Secretary for HPD Research—Ms.
Chi Do (Room 1522-A, x21784). The Chair of the HPD Research Committee will notify you by
letter about the Committee’s decision.



     Cover Page .....................................................................................................3

     Signature Page ...............................................................................................4

     Abstract ..........................................................................................................5

     Specific Aims .................................................................................................6

     Background and Significance.......................................................................7

     Research Design and Methods .....................................................................8

     Budget and Justification ...............................................................................9

     Safety Assurance .........................................................................................10

     Resources and Environment ......................................................................11

     Project Timeline ...........................................................................................12




                           Principal Investigator Cover Page


          Project Title (Type or Print):




          PROJECT START DATE: ___________                             PROJECT END DATE: __________




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       _________________________________________
       Name of Principal Investigator (TYPE OR PRINT)



       ________________________________________
       Title of Principal Investigator (TYPE OR PRINT)



       _______________________________________________________
       College and Department of Principal Investigator (TYPE OR PRINT)



       Requested Funding Amount:         ________________________________________________



       Faculty Advisor (if applicable)




                                 Signature Page

_______________________            ___________           Faculty Advisor (if applicable)



_______________________            ___________           Department Chair



_______________________            ___________           Associate Dean for Research



_______________________            ___________           Dean




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                                                          Biosafety Officer (if applicable)
_______________________              ___________          Dr. Harold Laubach x1303

                                                          Radiation Safety Officer (If applicable)
_______________________              ___________          Dr. Michelle Clark x1340


                                                          Chairman Research Committee
_______________________              ___________          Dr. Patrick Hardigan x1524



                                                          HPD Chancellor
_______________________              ___________          Dr. Fred Lippman x1501



PRINCIPAL INVESTIGATOR ASSURANCE:
       I certify that the statements herein are true, complete, and accurate to the best of
       my knowledge. I certify that individuals or NSU entities named herein are aware of
       their planned or potential involvement. I agree to accept responsibility for the
       scientific conduct of the project.


       ____________________________             ____________________
       Principal Investigator (Signature)     Date

                                            Abstract
       The purpose of the abstract is to describe succinctly every major aspect of the
       proposed project except the budget. The abstract is an important part of your
       application. It is used in the grant referral process, along with the other parts of the
       application.



                                     Specific Aims
       The purpose of the specific aims is to describe concisely and realistically what the
       proposed research is intended to accomplish.




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                      Background and Significance
        The purpose of the background and significance section is to state the problem to be
        investigated, the rationale for the proposed research, the current state of knowledge
        relevant to the proposal, and the potential contribution of this research to the
        problem(s) addressed.




                     Research Design and Methods
        The purpose of the research design and methods section is to describe how the
        research will be carried out. This section is crucial to how favorably an application
        is reviewed.




                          Budget and Justification
        The purpose of the budget and justification section is to present and justify all
        expenses required to achieve project aims and objectives. For multi-institutional
        applications, there must be a separate budget for each subcontractor or consortium
        member.




                                Safety Assurance
        The purpose of the assurances section is to ensure that the applicant organization
        will comply with all relevant federal laws and guidelines. The assurances section
        must address each of the following content items. If a content item is not applicable,
        write or type NA.

     1. Vertebrate Animals
        Insert description here or NA if not applicable

     2. Radioactive materials
        Insert description here or NA if not applicable

     3. Biohazard risk (include handling and disposal of carcinogens; toxic or flammable
        chemicals; toxins or toxic products; microbial agents or products including

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        bacterial, viral, fungal or parasitic organisms; human blood, body fluids, tissue
        from human subjects; and cells or tissue culture)
        Insert description here or NA if not applicable

     4. Recombinant DNA (including handling and disposal)
        Insert description here or NA if not applicable




                       Resources and Environment

        Purpose: The purpose of the resources and environment section is to describe the
        resources, facilities, and support available to the researcher. If a content item is not
        applicable, write or type NA.


     1. Consortium / Contractual Arrangements
        Insert description here or NA if not applicable

     2. Consultants / Collaborators (describe the relationship and attach letters of
        agreement with key consultants and collaborators. Please attach letters of
        commitment from named consultants and co-investigators)
        Insert description here or NA if not applicable

     3. Biosketch of all researchers, consultants, and collaborators
        Attach (2-page maximum) biosketch as an appendix

     4. Major equipment: (List the most important equipment items already available for
        this project, noting the location and pertinent capabilities of each.)
        Insert description here or NA if not applicable

     5. Laboratory space
         Insert description here or NA if not applicable

     6. Clinical space
         Insert description here or NA if not applicable

     7. Fixed clinical equipment
         Insert description here or NA if not applicable

     8. Animal facilities
         Insert description here or NA if not applicable



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     9. Other relevant equipment
         Insert description here or NA if not applicable


                                 Project Timeline

        Purpose: Applicants should construct the project timeline to include critical
        milestones, measurable outcomes, and mid-term and end of project deliverables to
        be publicly shared as expeditiously as possible. A




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