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									       Designated & General Funding
      Grant Application & Instructions
                                        ORA FORM 110




The mission of Barnes-Jewish Hospital Foundation is to provide financial support to help the Hospital
fulfill its purpose. Funds are used to support medical research, patient care, education, and community
service projects that otherwise would not be available to the Hospital.
                                        BARNES-JEWISH HOSPITAL FOUNDATION
                                                 GRANT APPLICATION
                                          (Designated & General Funding Request)

              ORA FORM 110 contains information for preparing a grant application to Barnes-Jewish Hospital
              Foundation for:
                     Designated Funding
                     -        Bench and Clinical Research and Non-Research Grants for investigators who
                              currently have funds assigned and/or designated for their use.

                         General Funding
                         -     Non-Research Grants which are new or supplementing a previous General
                               Funding request.
                         -     Special requests, both research and non-research that are made on the behest
                               of Hospital Administration and/or the Dean of Washington University School
                               of Medicine.
              Notes:

                        If you are interested in a applying for a new clinical/translational research grant, applications are
                         accepted through the Clinical/Translational Research Grant Program. To participate in this
                         program, a separate application (ORA Form 310) is required and is available at the Office of
                         Research Affair’s website.

                        New bench research applications will only be accepted in response to a formal request for
                         applications. At the time a request is made, the application will be available at the Office of
                         Research Affair’s website.

              Please be sure to bookmark this website (http://www.barnesjewish.org/groups/default.asp?NavID=2165) for
              future reference and for instructions on submitting grant applications to the Barnes-Jewish Hospital Foundation.

              Applicants should read and follow the attached instructions carefully to avoid delays, misunderstandings,
              and the possible return of an application. Barnes-Jewish Hospital Foundation may return an application if
              it fails to adhere to its requirements.

              The deadline for filing an application is 5:00 p.m on the submission date. Late applications will not be
              accepted. The original application and an additional copy should be sent to the Office of Research
              Affairs, Mailstop 90-94-212 or delivered to the Office of Research Affairs, 600 South Taylor, Suite 222,
              St. Louis, MO 63110. Any questions should be directed to Bettina Lampkin, Grants Coordinator, at 286-
              0349 in the Office of Research Affairs.

                                               GRANT PROCESSING SCHEDULE

                        Type of Request              SUBMISSION DATES TO                           EARLIEST START
                           Accepted                          ORA                                       DATES
                           Designated                           February 1st                               April 1st
                    General & Designated                          May 1st                                   July 1st
                           Designated                            August 1st                               October 1st
                    General & Designated                       November 1st                               January 1st


(Effective 01/07)                                                       2                                   ORA FORM 110-I
                                                                                                            (Revised 01/17/07)
                                     TERMS AND CONDITIONS OF GRANT
EXPENDITURE GUIDELINES
     A.   Indirect Cost
          Barnes-Jewish Hospital Foundation will provide indirect costs to WUSM applicants as follows:
             10% for clinical/translational research
             10% for non-research support (e.g., education)
             20% for bench research
          Grants funded from BJH Foundation Endowed Chairs and Special Requests (e.g. recruitment funds)
          as approved by WUSM will not receive indirect costs.

          Please use the applicable rate when completing budget pages.

          Indirect costs do not apply to Barnes-Jewish Hospital applicants.
B.        Equipment
          A detailed description of the equipment must be provided with an explanation of how it directly relates to
          the project. Equipment is defined by the grantee’s institutional capital policy.
C.        Travel
          Travel must adhere to the grantee’s established travel policy. The relationship of the traveler to the grant
          must be identified.

D.        Consortium
          The participating consortium organization must submit a separate face page and detailed budget for both
          the initial budget period (Form Page 8) and the entire proposed project period (Form Page 9).

          Consortium arrangements may involve personnel costs, supplies, and other allowable costs, including
          indirect costs. (Please note: WUSM applicants cannot take indirect on a Consortium arrangement
          with BJH.
E.        Contractual Costs
          Contractual arrangements (e.g. laboratory testing, clinical services or data processing) must be supported
          by a letter from the contracted institution which defines the terms and documents their agreement to
          participate.

          These costs should be reflected in the other expense budget category.
F.        Pre-Award Costs
          An applicant may, at their own risk and without prior approval from the Foundation, incur obligations and
          expenditures to cover costs up to 90 days before the beginning date of the initial budget
          period if such costs:
                         are necessary to conduct the project, and
                         would be allowable under the grant, if awarded.

G.        Unallowable Expenditures
          Barnes-Jewish Foundation will not fund the following:
                       Administrative or institutional charges for services normally considered overhead, (e.g.,
                          space rental, utilities, etc.)
                       Tuition (excluding scholarships)
                       Dependent tuition fringe benefit
                       Dues and membership fees (excluding professional organizations or societies)
                       Entertainment/social expenses or other non-business related activities (e.g., office parties,
                          amusements, diversion, etc.)
                          Prior period costs (excluding pre-award costs)
                       Any expense contrary to applicant’s institutional reimbursement policies

          The Foundation reserves the right to question and/or disallow a cost that it deems inappropriate.
                REPORTING GUIDELINES
                    A.   Interim Progress Report (Applicable Only to Multi-Year Awards)
                            An Interim Progress Report is due 90 days prior to the end of the budget period for Year One and
                            should be submitted on ORA Form 105 (Progress Report Form). The Foundation will not award
                            Year Two funding and/or new applications if a progress report has not been received for a
                            previous grant.

                    B. Final Progress Report
                            A Final Progress Report is due 60 days after the end of the project period identified on the Notice
                            of Grant Award/Letter of Agreement and should be submitted on ORA Form 105 (Progress
                            Report Form). The Foundation will not fund a request for new/additional funding if an applicant’s
                            progress report has not been received for a previous grant.

                    C. Invoicing (Applicable to WU Only)
                            Quarterly invoices summarized by line item should be directed to the Office of Research Affairs,
                            Barnes-Jewish Hospital, Mail Stop #90-94-212, 600 South Taylor, Suite 222, St. Louis, MO
                            63110. A final invoice must be submitted within 60 days of the grant budget period. The indirect
                            cost rate used in invoicing, if applicable, must correspond with the rate identified in the Letter of
                            Agreement. The final invoice will not be paid until the final progress report has been
                            received.

                            Unexpended funds revert back to Barnes-Jewish Hospital Foundation.

                ADMINISTRATIVE GUIDELINES
                    A. Change in Scope
                            Any change in the direction, type of research or program/activity, or other areas that constitute a
                            significant change from the aims, objectives, or purposes of the approved project must be
                            approved in advance by the Grantee’s institutional official and the Office of Research Affairs.

                    B. Budget Changes
                            Rebudgeting is allowed if it meets the purpose of completing the project. Funds may not be
                            rebudgeted for items deleted from the original budget. Any rebudgeting that changes a budget
                            category by 25% or greater must be addressed in the progress report.

                            Significant rebudgeting requires approval in advance by the Grantee’s institutional official and the
                            Office of Research Affairs. This occurs when expenditures in a single direct cost budget category
                            increase or decrease from the categorical commitment level established for the budget period by
                            more than 25% percent of the total costs awarded. For example, if the award budget for total
                            costs is $100,000, any rebudgeting that would result in an increase or decrease of more than
                            $25,000 in a budget category would be considered “significant rebudgeting”.

                    C. No-Cost Extension
                            Requests for extensions must be submitted two weeks prior to the date of expiration. An
                            extension may be granted for up to one year, as needed, to complete the work. Requests must be
                            approved by the Grantee’s Institutional official and the Office of Research Affairs. Justification
                            must be provided with the request.




(Effective 01/07)                                                    4                                   ORA FORM 110-I
                                                                                                         (Revised 01/17/07)
                         D. Carry Forwards
                                 Requests for carry forwards will be automatic unless the carry forward amount exceeds 25% of the
                                 total award. In the event the carry forward exceeds 25% of the award, a justification is required
                                 and must be included with the Progress Report on ORA Form 105. Carry forward request that
                                 exceed 25% of the total award must be approved by the Grantee’s institutional official and the
                                 Office of Research Affairs.

                         E. Change in Percent of Effort
                                 Grantees are required to devote adequate effort to complete the project. Any change to the
                                 original commitment of effort must be approved by the Grantee’s institutional official and the
                                 Office of Research Affairs. Justification should be provided with the request.

                         F. Change in Grantee or Grantee Institution
                                 Changes in the Grantee must be approved in advance by Grantee’s institutional official and the
                                 Office of Research Affairs. No changes in the Grantee Institution will be allowed.

                         G. Acknowledgement of Funding
                                 Barnes-Jewish Hospital Foundation must be acknowledged in any publication or presentation
                                 resulting from a Foundation grant. All grant recipients are required to report any publications on
                                 ORA Form 105 (Progress Report Form). Copies of all abstracts and reprints acknowledging
                                 Barnes-Jewish Hospital Foundation must be submitted to the Office of Research of Affairs.

                         H. Discoveries/Inventions
                                 Discoveries and/or inventions resulting from Barnes-Jewish Hospital Foundation funding will
                                 be subject to Barnes-Jewish Hospital’s policy on Intellectual Property. All grant recipients are
                                 required to report discoveries/inventions on ORA Form 105 (Progress Report Form). For
                                 WUSM applicants, Barnes-Jewish Hospital and Washington University will negotiate mutually
                                 acceptable terms at the time a discovery or invention is disclosed or conceived.




                                                        OTHER DOCUMENTATION

                Project Narrative
                        The project narrative should not exceed three pages. It should include a brief description of the
                        objectives, timelines, expected outcomes, the role of any consortium/contractual institution (if
                        applicable), and an explanation of how the project will directly and/or indirectly impact patients.

                Budget
                         The attached budget form(s) must accompany the application. If applicable, a budget for the
                         consortium institution must accompany the application. Applicable letters from contracted
                         institutions and/or parties must also accompany the application.




(Effective 01/07)                                                        5                                  ORA FORM 110-I
                                                                                                            (Revised 01/17/07)
                      INSTRUCTIONS FOR COMPLETING GRANT APPLICATION

                Item 1.   Title of Project: Choose a title that is descriptive of the goals that you desire to
                          accomplish. If this is a continuation grant request, use the same title of the original
                          proposal.

                Item 2.   Type of Grant: Please identify whether your grant is a Designated Funding Request
                          (Applicants with funding assigned or designated for their use) or a General Funding
                          Request (New or Supplemental Non-research requests or Special Request approved by
                          Hospital Administration). If a Designated Funding Request, please identify if it is for a
                          research or a non-research purpose. If research, identify if Bench or Clinical/translational
                          research. If this application is for a General Funding Request, please identify the
                          category that best describes the primary area of impact.

                Item 3.   Applicant Information: Name the primary individual responsible for the direction and
                          completion of the project.

                Item 4.   Human Investigation: The Investigator must obtain approval from the Institutional
                          Review Board (IRB) if the proposed project involves humans. A copy of the IRB
                          approval letter must be submitted prior to the inception of the grant to the Office of
                          Research Affairs. IRB approval must extend for the entire funding period.

                          Animal Investigation: The Investigator must obtain approval from the Institutional
                          Animal Care and Use Committee (IACUC) if the proposed project involves animals. A
                          copy of the IACUC approval letter must be submitted prior to the inception of the grant
                          to the Office of Research Affairs. IACUC approval must extend for the entire funding
                          period.

                Item 5.   Identification of Funding Sources: Identify any BJH Foundation funds currently
                          assigned to the applicant which could be used as funding sources for direct costs.

                Item 6.   Dates of Project Period: Enter the beginning and ending dates of the project. The
                          beginning date must conform to the Grant Processing Schedule.

                Item 7.   Total Requested for Initial Budget Period:
                                 7a. Direct Costs:      Enter Direct Costs from ORA FORM 110A, Line 11.
                                  7b. Total Costs:          Enter Total Costs from ORA FORM 110A, Line 13.

                Item 8.   Total Requested for Project Period (applies to multi-year requests.):
                                 8a. Direct Costs:      Enter Total Costs from ORA FORM 110B, Line 11
                                  8b. Total Costs:          Enter Total Costs from ORA FORM 110B, Line 13

                Item 9.   Signatures: Applicant and institutional signatures are required. The institutional
                          signature for a Washington University applicant is the Washington University Grants and
                          Contracts Office. The institutional signature for a Barnes-Jewish Hospital applicant is
                          the applicant’s Department Head.

(Effective 01/07)                                              6                                ORA FORM 110-I
                                                                                                (Revised 01/17/07)
                                          Barnes-Jewish Hospital Foundation
                                    Designated & General Funding Grant Application
  1. Title of Project


  2. Type of Grant                  Designated Funding Request                            General Funding Request          (See Instructions for Grant Application)

                          Designated Funding                                                                General Funding Request
                                                                                        Education
          Clinical/Translational Research               New                                                                                 New
                                                                                        Capital
          Bench Research                                Supplemental                                                                        Supplemental
                                                                                        Patient Care
          Non-Research
                                                                                        Other __________________

  3. Applicant Information

      Name: (Last, First, MI)                                              Degree(s) (e.g., MD, PhD, RN)            Phone Number         Fax Number


      Title                                                                Applicant’s Mailing Address:

      Applicant Organization


      Department                             Division
                                                                           Applicant’s E-mail Address:

                                                                           Administrative E-mail Address:                 Administrative Phone Number:
      Administrative Contact Name:


  4. Human Subjects:          Yes            No         Please note:
                                                        A copy of the IRB/IACUC approval, if applicable, is required to be submitted to ORA
     Animal Subjects:         Yes            No         before the inception of the grant.

  5. Do you have current BJH Foundation funds designated to you which could be used as funding source(s) to support direct costs?                  Yes        No
  If yes, please identify fund(s) and amounts requesting to use from each below.
       Fund Number                   Amount                   Fund Number                        Amount              Fund Number                     Amount




  6. Dates of Project Period (MM/DD/YY)                    7. Total Requested for Initial Budget Period 8. Total Requested for Project Period

  From                        Through                         7a. Direct Costs ($)            7b. Total Costs ($)   8a. Direct Costs ($)        8b. Total Costs ($)



  9. I, the undersigned, certify that the statements herein are true Official Signing for Applicant Organization (Please Print Name)
  and completed to the best of my knowledge. I agree to comply       Name:
  with all policies, terms, and conditions of Barnes-Jewish Hospital
  Foundation.                                                        Title:

                                                                                       Address:
  Principal Investigator/Program Director:
  (Please Print Name)                                                                  Tel:

                                                                                       E-mail:


  Signature:                                              Date:                        Signature:                                                Date:



(Effective 01/07)                                                                  7                                         ORA FORM 110
                                                                                                                           (Revised 01/17/07)
                    Applicant’s Name (Last, First, Middle):

                                                                                                 FROM                  THROUGH
                    DETAILED BUDGET FOR INITIAL BUDGET PERIOD

      1. PERSONNEL                                                                      %         DOLLAR AMOUNT REQUESTED (omit cents)


                                                                          Please
                                                                        Identify as   EFFORT
                                                              ROLE ON   WU or BJH       ON       SALARY      FRINGE
                               NAME                           PROJECT   Employee       PROJ.   REQUESTED    BENEFITS            TOTAL




                                              SUBTOTALS
      2. CAPITAL EQUIPMENT OR RENOVATION (Itemize)




      3. TRAVEL



      4. PUBLICATIONS


      5. CONSUMABLE SUPPLIES (Itemize by category)




      6. PATIENT CARE


      7. STIPENDS


      8. CONSULTANT(S)


      9. CONSORTIUM


      10. OTHER EXPENSES (Itemize by category)




      11. SUBTOTAL DIRECT COSTS FOR INITIAL BUDGET PERIOD
      12. Indirect Cost (WUSM applicants only)


      13. TOTAL COSTS FOR INITIAL BUDGET PERIOD                                                                           $

(Effective 01/07)                                                            8                             ORA FORM 110A
                                                                                                           (Revised 01/17/07)
                    Applicant’s Name (Last, First, Middle):



                                                  BUDGET FOR ENTIRE PROJECT PERIOD


                                             INITIAL BUDGET
                                                  PERIOD                2nd                     Total
           BUDGET CATEGORY
               TOTALS


     1. PERSONNEL



     2. CAPITAL EQUIPMENT OR
     RENOVATIONS



     3. TRAVEL



     4. PUBLICATIONS



     5. CONSUMABLE SUPPLIES



     6. PATIENT CARE



     7. STIPENDS



     8. CONSULTANT(S)



     9.CONSORTIUM



     10. OTHER EXPENSES



     11. TOTAL DIRECT COSTS




     12. INDIRECT COST
     (WUSM applicants only)



      13. TOTAL COSTS FOR
      PERIOD
                                                                                           $



(Effective 01/07)                                                9                   ORA FORM 110B
                                                                                     (Revised 01/17/07)

								
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