SDSU-UCSD_Partnership_2009_Application_Form

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SDSU-UCSD_Partnership_2009_Application_Form Powered By Docstoc
					COMPREHENSIVE SDSU-UCSD CANCER CENTER PARTNERSHIP 2009 APPLICATION FOR U54 PILOT PROJECTS
SDSU Co-Leader & Academic Title
SDSU Co-Leader’s Cancer Center Research Program Affiliation Department & Mail Code

Phone Number & Email

UCSD Co-Leader & Academic Title
UCSD Co-Leader’s Cancer Center Research Program Affiliation

Department & Mail Code

Phone Number & Email

CBO Co-Leader & Title (if applicable)
Co-Leader’s Cancer Center Research Program Affiliation (if applicable)

Department & Mail Code

Phone Number & Email

Project Title

This project involves:

Human Subjects

Animal Subjects

Recombinant DNA Research

Signature: SDSU Co-Leader Signature: UCSD Co-Leader Signature: CBO Co-Leader Please prepare the application in the following format, with parts B-D not to exceed 10 pages. Use blank pages as needed. A. B. C. D. E. Scientific Abstract (up to 150 words) Specific Aims and Significance Rationale for SDSU-UCSD Collaboration Research Design and Methods References F. G H. I. Biographical Sketches of Key Personnel (up to 2 pages each) Other Support of Key Personnel (up to 2 pages each) Proposed Duration of Project _________ months (up to 24 months) Budget for each Institution, SDSU and UCSD, and CBO (if applicable) Budget Justification (up to 2 pages)

A.

SCIENTIFIC ABSTRACT (up to 150 words)

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SDSU-UCSD CANCER CENTER PARTNERSHIP 2009 APPLICATION FOR U54 PILOT PROJECTS CONTINUATION PAGE – Sections B through E (Note: 10-page limit for Sections B-D)

B. SPECIFIC AIMS AND SIGNIFICANCE

C. RATIONALE FOR SDSU-UCSD COLLABORATION

D. RESEARCH DESIGN AND METHODS

E. REFERENCES

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SDSU-UCSD CANCER CENTER PARTNERSHIP 2009 APPLICATION FOR U54 PILOT PROJECTS F. BIOGRAPHICAL SKETCH (Please note that PHS398 NIH Bio Sketch Form is acceptable)
Name Position Title

EDUCATION/TRAINING – Begin with baccalaureate or other initial professional education and include postdoctoral training. Institution and Location Degree Year(s) Field of Study

RESEARCH AND PROFESSIONAL EXPERIENCE – On one page list previous employment and experience, concluding with present position. Using one additional page, list all relevant publications during the past three years. Paste your information below.

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SDSU-UCSD CANCER CENTER PARTNERSHIP 2009 APPLICATION FOR U54 PILOT PROJECTS G. OTHER SUPPORT (Please note that PHS398 NIH Other Support Form is acceptable)
For each key person, list active and pending grants stating: a) title of project; b) funding source; c) performance dates; d) role on project and percent efforts; and e) the major goals of the project. Paste information below.

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SDSU-UCSD CANCER CENTER PARTNERSHIP 2009 APPLICATION FOR U54 PILOT PROJECTS H. DETAILED BUDGET
Using the format of PHS 398, budget the estimated costs associated with conducting the research at SDSU and UCSD. Estimated costs are acceptable and need not be final. Complete a detailed budget page for the budget period using Form Page 4. Please provide separate budget pages for SDSU and UCSD. If applicable, provide separate budget pages for CBO. This budget is for: SDSU UCSD CBO (if applicable)

DETAILED BUDGET FOR INITIAL BUDGET PERIOD DIRECT COSTS ONLY
PERSONNEL (Applicant organization only) NAME ROLE ON PROJECT
Months Devoted to Project

FROM

THROUGH

DOLLAR AMOUNT REQUESTED (omit cents)

Cal. Mnths

Acad. Mnths

Summer INST.BASE Mnths SALARY

SALARY REQUESTED

FRINGE BENEFITS

TOTAL

Co-Leader

SUBTOTALS
CONSULTANT COSTS EQUIPMENT (Itemize)

SUPPLIES (Itemize by category)

TRAVEL PATIENT CARE COSTS

INPATIENT OUTPATIENT

ALTERATIONS AND RENOVATIONS (Itemize by category)

OTHER EXPENSES (Itemize by category)

CONSORTIUM/CONTRACTUAL COSTS

DIRECT COSTS

SUBTOTAL DIRECT COSTS FOR INITIAL BUDGET PERIOD (Item 7a, Face Page)
CONSORTIUM/CONTRACTUAL COSTS FACILITIES AND ADMINISTRATIVE COSTS

$

TOTAL DIRECT COSTS FOR INITIAL BUDGET PERIOD
PHS 398 (Rev. 04/06) 38a16aad-e03c-4cd8-b328-9d994b9c3595.doc Page

$
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SDSU-UCSD CANCER CENTER PARTNERSHIP 2009 APPLICATION FOR U54 PILOT/ FULL PROJECTS I. BUDGET JUSTIFICATION
Describe below the need for each SDSU and UCSD budget item, starting with personnel costs. Please provide separate budget justifications for SDSU and UCSD. If applicable, provide separate budget justifications for CBO. Do not exceed two pages.

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