VIRGINIA COMMONWEALTH UNIVERSITY

Center for Clinical and Translational Research

CCTR Endowment Fund Multi-School Grant Application

Cover Page

INVESTIGATORS

Corresponding PI Name: ______Academic Rank: ______

School: ______Department: ______

P.O. Box: ______E-mail: ______eRA Commons Name: ______

Tenure Status:  Full-Time, Tenured  Full-Time, Non-tenured

Collaborators:

Co-PI Name(s) / School/Department / eRA Commons Name / Tenure
Status*

* T = Full-Time, Tenured and N = Full-Time, Non-tenured

RESEARCH

Type of research:  Basic  Clinical/Translational  Community

Is this a revised application?  Yes  No

Project Title: ______

Key Words: ______

Amount Requested: $______

PI Signature: ______Date: ______

Co-PI Signature: ______Date: ______

Co-PI Signature: ______Date: ______

Endorsement of Department Chairs

For PI:

As Chairman of the Department of ______, I endorse this application

and the information provided above. This project will be conducted in

______, which will be available for this purpose.

(room and building)

Department Chairman: ______

Signature: ______Date: ______

For co-PI:

As Chairman of the Department of ______, I endorse this application

and the information provided above.

Department Chairman: ______

Signature: ______Date: ______

For co-PI:

As Chairman of the Department of ______, I endorse this application

and the information provided above.

Department Chairman: ______

Signature: ______Date: ______

Previous and Current Collaborations

Provide a brief description of any project(s), funded or unfunded, on which at least part of your research team is collaborating/has collaborated previously. The description should include the title of the project/grant, a one-sentence description of the project/grant, your roles on the project/grant, the amount (if applicable), the funding period (if applicable), and the source of support (if applicable). If your research team has previously received support from this or any other small grant program at VCU, list subsequent external grants applied for, funding decisions (funded/not funded), source of funds, dates, and amounts. Finally, please list any publications generated by your research team.

Has support for this or a similar project been requested from other internal sources?

(e.g., Cancer Center) or from external agencies (e.g., NIH, NSF)?

No _____ Yes _____

If yes, please state the funding source to which you applied, amount requested, and period of support.

List of Collaborators

List of collaborators identifying their roles in the research (i.e., co-PI, co-Investigator, etc.) and describing their responsibilities with regard to the proposed project. Also, describe the governance and organizational structure of the leadership team, including communication plans, process for making decisions on scientific direction, and procedures for resolving conflicts.Finally, list all other persons (students, technicians, house staff, etc.) who will be assisting you with this project.

Budget

Please provide the following budgetary information: Itemize and identify any item in excess of $500. (Chemicals may be grouped into major categories such as solvents, radio-labeled compounds, enzymes, fine biochemicals, antibodies, etc.)

EQUIPMENT ______

CONSUMABLE SUPPLIES ______

PERSONNEL (See instructions for restrictions) ______

ADDITIONAL EXPENSES (State purpose and justify) ______

TOTAL ______

CCTR Endowment Fund Grant Application (2015May05) Page 1