Competitive Medical Research Fund (CMRF)
Program Director/Principal Investigator:
(Last, first, middle)
CMRF Application Check ListThis Checklist
SignedFace Page
Signed Cost Share Agreement Page
CMRFEligibility ClarificationPage
Letter of Support from Department Chair
Abstract Page (Include a second copy as a separate PDF file)
Table of Contents
Budget, including budget justification
Biosketch(es) of PI and all Co-Investigators
Research Plan:
Introduction (if a resubmitted application, 1-page limit*)
Specific Aims (1-page limit*)
Research Strategy (6-page limit*)
*Any application exceeding the page limitations will be withdrawn from consideration without review.
Human Subjects (if applicable, 2-page limit)
Vertebrate Animals (if applicable, 2-page limit)
Bibliography (no limit)
Letters of Collaboration (if applicable)
Appendices:
Abstracts of other support for PI and all co-investigators (required; if the applicantworkswithin the laboratory of a more
senior investigator, he/shemust include abstracts of the active and pending research projects of that senior
investigator, even if this person is not a co-investigator on the CMRF project.)
K Award application abstract (K awardees only; see instructions)
Publications and Manuscripts (if applicable, three maximum)
Application Form for Research Grant Support
Face Page (Page 1)
/ FORM MUST BE TYPEWRITTENPrincipal Investigator:______
(Last Name, First Name, Degree(s)) / Rank(check only one) / Research Assistant
Professor / Assistant Professor
Research Associate
Professor / Associate Professor
Years of Budget Requested / 1 Yr 2 Yrs / Total Cost for Project ______
All Categories) / Year 1 / Year 2
Primary Dept. and Division:______/ Have you previously applied for funding from the CMRF?
If “Yes,” when? ______/ Yes No
Telephone:______Fax:______/ Is this a revised CMRF application? / Yes No
Research Compliance
Does this research use:
Recombinant DNA?
If “Yes,” IBC approval will be required
before an award can be made. / Yes No
Title of Investigation:______
______
______
Location/Facility for Completion of Project:
______/ Human Subjects?
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
Human Stem Cells?
If yes, hSCRO approval will be required
before an award can be made. / Yes No
Recently Deceased Humans?
If yes, CORID approval will be required
before an award can be made. / Yes No
Do not submit IBC, IRB, IACUC, hSCRO 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 SupervisorDate
______
Print or type name of Principal Investigator’s SupervisorDate
Submit proposals to: / Selena A. Crawford, CMRF CoordinatorScaife Hall, Suite 401
3550 Terrace Street
Pittsburgh, PA 15261
412.648.2233 (telephone)
CMRF Agreement to Cost Share
Please note that all information requested below is required.
Project Title:
Name and Degree:
Academic Title:
Primary Departmental Affiliation:
Campus Address:
Telephone Number:
E-mail address:
Department Chair’s Signature*
Institutional Account Number
* Department chair or appropriate Responsibility Center Director (e.g., division chief or institute director) who can authorize cost sharing against an Entity-02 or -04 institutional account. This signature certifies acceptance of primary investigator cost shared effort and no indirect cost.
CMRF Eligibility ClarificationPage
UPMC Health System Competitive Medical Research Fund (CMRF)
Principal Investigator: ______
Title of Investigation: ______
______
Form must be typewritten. If morespace is needed, please use one additional page for each section.
- Summarize your need for funding from the CMRF for the proposed project.
- If the CMRF application represents a request for funds to extend an ongoing project into a new direction, it is essential to specify clearly how the proposed project differs from the ongoing research. The source of funding for the ongoing research should be identified, and the reason(s) why that source is not available for the CMRF-proposed project should be given.
- If the application is for research that is an extension of an ongoing project (for which either you OR someone else is the principal investigator), indicate how your proposed project is different from that project. (If you work in the laboratory of a senior investigator, you must clearly indicate how funding will be used for your independent research program and not merely to fund the project or personnel of the senior investigator. Note, it is not sufficient to state that the research is different. Details of the distinctions between the projects must be provided. Please note that you must attach the senior investigator’s “Other Support” pages as well as abstracts of their active and pending research projects, even if this person is not a co-investigator on your CMRF project.)
ABSTRACT
Program Director/Principal Investigator (Last, First, Middle):PROJECT/PERFORMANCE SITE(S) (if additional space is needed, use Project/Performance Site Format Page)
Project/Performance Site Primary Location
Organizational Name:
DUNS:
Street 1: / Street 2:
City: / County: / State:
Province: / Country: / Zip/Postal Code:
Project/Performance Site Congressional Districts:
Additional Project/Performance Site Location
Organizational Name:
DUNS:
Street 1: / Street 2:
City: / County: / State:
Province: / Country: / Zip/Postal Code:
Project/Performance Site Congressional Districts:
PHS 398 (Rev. 6/09)Form Page
Program Director/Principal Investigator (Last, First, Middle):SENIOR/KEY PERSONNEL. See instructions. Use continuation pages as needed to provide the required information in the format shown below.
Start with Program Director(s)/Principal Investigator(s). List all other senior/key personnel in alphabetical order, last name first.
Name / eRA Commons User Name / Organization / Role on Project
OTHER SIGNIFICANT CONTRIBUTORS
Name / Organization / Role on Project
PHS 398 (Rev. 6/09)Form Page
CMRF Research APPLICATION
TABLE OF CONTENTS
Page NumbersChecklist ………………………………………………………………………………………………………….
Face Page......
Cost Sharing Agreement Page…………………………………………………………………………………
CMRF Eligibility Clarification Page......
Letter of Support from Department Chair......
Abstract Page......
Detailed Budget for Initial Budget Period......
Budget for Entire Proposed Period of Support with Justification......
Biosketches for PI / co-PI and all co-Investigators (4-page maximum for each)
Research Plan......
Introduction(required for revised CMRF application only; not to exceed one page) / Introduction / Response to critique(required for revised CMRF application only; not to exceed one page)
Specific Aims......
Research Strategy......
Human Subjects Research (if applicable, 2-page limit)......
Vertebrate Animals (if applicable, 2-page limit)......
Bibliography (no limit)......
Letters of Collaboration(if applicable)......
Appendix (edit the following list as needed)......
Abstracts of other support for PI and all co-investigators (required)
K Award application abstract (K awardees only; see instructions)
Publications and Manuscripts (if applicable, three maximum)
CMRF Form Page
DETAILED BUDGET FOR INITIAL BUDGET PERIOD
DIRECT COSTS ONLY
/ FROM / THROUGHList PERSONNEL(Applicant organization only)
Use Cal, Acad, or Summer to Enter Months Devoted to Project
Enter Dollar Amounts Requested (omit cents) for Salary Requested and Fringe Benefits
NAME / ROLE ONPROJECT / Cal.
Mnths / Acad.
Mnths / Summer
Mnths / INST.BASE
SALARY / SALARY
REQUESTED / FRINGE
BENEFITS / TOTAL
PD/PI
SUBTOTALS
CONSULTANT COSTS
EQUIPMENT (Itemize)
SUPPLIES (Itemize by category)
TRAVEL
INPATIENT CARE COSTS
OUTPATIENT CARE COSTS
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. 6/09)Form Page
BUDGET CATEGORYTOTALS / INITIAL BUDGET
PERIOD
(from Form Page 4) / 2nd ADDITIONAL YEAR OF SUPPORT REQUESTED
PERSONNEL: Salary and fringe benefits. Applicant organization only.
CONSULTANT COSTS
EQUIPMENT
SUPPLIES
TRAVEL
INPATIENT CARE
COSTS
OUTPATIENT CARE
COSTS
ALTERATIONSAND
RENOVATIONS
OTHEREXPENSES
DIRECT CONSORTIUM/
CONTRACTUAL
COSTS
SUBTOTALDIRECTCOSTS
(Sum = Item 8a, Face Page)
TOTAL DIRECT COSTS
TOTAL DIRECT COSTS FOR ENTIRE PROJECT PERIOD
JUSTIFICATION. Follow the budget justification instructions exactly. Use one continuation page if needed.
PHS 398 (Rev. 6/09)Form Page
BIOGRAPHICAL SKETCH
Provide the following information for the Senior/key personnel and other significant contributors in the order listed on Form Page 2.Follow this format for each person. DO NOT EXCEED FOUR PAGES.
NAME / POSITION TITLE
eRA COMMONS USER NAME (credential, e.g., agency login)
EDUCATION/TRAINING (Begin with baccalaureate or other initial professional education, such as nursing, include postdoctoral training and residency training if applicable.)
INSTITUTION AND LOCATION / DEGREE
(if applicable) / MM/YY / FIELD OF STUDY
- Personal Statement
- Positions and Honors
- Selected Peer-Reviewed Publications (limit 15)
- Research Support (ongoing and completed projects for the past three years)
Please refer to the Biographical Sketch sample ( ) in order to complete sections A, B, C, and D of the Biographical Sketch.
OTHER SUPPORT
Format
NAME OF INDIVIDUALACTIVE/PENDING
Project Number (Principal Investigator)
Source
Title of Project (or Subproject)
The major goals of this project are… / Dates of Approved/Proposed Project
Annual Direct Costs / Person Months
(Cal/Academic/
Summer)
OVERLAP (summarized for each individual)
Principal Investigator (Last, First, Middle):