Revised: August 2016 / 1

Research Proposal/Grant Preparation

Application Form

To request our services, please send the completed Application Form with the required documents to: . Incomplete applications will not be evaluated.

  1. Required Documents

In orderto approve your request, we will need the following documents to be submitted as pdf electronic files. These documents will be sent to the NIH in order to report our outcomes and justify our budget. (To open the links hold down “Ctrl” button).

Biographical Sketch (PI)

PI Training Certifications(Human Subject Protection HIPAA)& IACUC Training Certifications (if applicable)

If you have any questions, please contact the Regulatory Knowledge and Support Coordinator Ms. Madeline Maldonado () (787-759-0306 ext. 232).

The evaluation process for this request can take from 2 to 4 working days.

  1. PRCTRC Core Request

Please select the support requested for preparing your research proposal/grant. Select all that apply.
Regulatory Knowledge and Support (RKS)
Develop/Review Informed Consent Document / SupportwithIRB Submission
Review Human Subject Protection Regulations / Other, specify:
Administrative Core (AC)
Budget preparation/justification
Support for research proposal submissionfor funding
Other, specify:
Research Design and Biostatistics Core (RDB)
Database design (including REDCap) / Research Ethics Consultation
Questionnaire design / Informed Consent Validity
Research design / Protection for Vulnerable Populations
Sample size and power calculation / Other, specify:
Sampling procedures of study participants
Statistical analysis plan
Biomedical Informatics Core (BIC)
Computer equipment with Internet and Intranet connections for literature search(Computer Cluster Facility)
Set up an account to access REDCap (REDCap test server)
Other, specify:
Scientific Writing Unit (SWU)
Scientific writing and editing for a Research Proposal Application
Initial submission of research proposalfor funding
Resubmission of research proposalfor funding
Other, specify:
  1. Investigator(s) Information

  1. First Name:

  1. Last Name:

  1. Degree:
/ Select degreePhDMDMD/PhDPsyDEdDDVMDMDMSMPHOther, specify:
  1. Current Position:
/ Select positionAssistant ProfessorAssociate ProfessorAdjunt ProfessorVisiting ProfessorProfessorInstructorInvestigators/ResearcherOther, specify:
  1. Institution:
/ Select academic affiliationUPR Medical Sciences CampusPonce Health Sciences UniversityUniversidad Central del CaribeUPR Comprehensive Cancer CenterUPR Rio Piedras Other, specify:
  1. School:
/ Select schoolSchool of Dental MedicineSchool of Health ProfessionalsSchool of MedicineSchool of PharmacySchool of Public HealthOther, specify:
  1. Department:
/ Select departmentBasic Sciences DepartmentClinical Sciences DepartmentEcological Sciences DepartmentEnvironmental HealthEpidemiology and BiostatisticsGraduate DepartmentHealth Services AdministrationHuman DevelopmentPost-doctoral ProgramRestorative Sciences DepartmentSocial SciencesSub Graduate DepartmentSurgical Sciences DepartmentOther, specify:
  1. Program:

Email:
Phone (XXX-XXX-XXXX):

Co- PI or Co-Investigator

First Name:
Last Name:
  1. Degree:
/ Select degreePhDMDMD/PhDPsyDEdDDVMDMDMSMPHOther, specify:
Current Position: / Select positionAssistant ProfessorAssociate ProfessorAdjunt ProfessorVisiting ProfessorProfessorInstructorInvestigators/ResearcherOther, specify:
Institution: / Select academic affiliationUPR Medical Sciences CampusPonce Health Sciences UniversityUniversidad Central del CaribeUPR Comprehensive Cancer CenterUPR Rio Piedras Other, specify:
School: / Select schoolSchool of Dental MedicineSchool of Health ProfessionalsSchool of MedicineSchool of PharmacySchool of Public HealthOther, specify:
Department: / Select departmentBasic Sciences DepartmentClinical Sciences DepartmentEcological Sciences DepartmentEnvironmental HealthEpidemiology and BiostatisticsGraduate DepartmentHealth Services AdministrationHuman DevelopmentPost-doctoral ProgramRestorative Sciences DepartmentSocial SciencesSub Graduate DepartmentSurgical Sciences DepartmentOther, specify:
Program:
Email:
Phone (XXX-XXX-XXXX):

First Name:
Last Name:
Degree: / Select degreePhDMDMD/PhDPsyDEdDDVMDMDMSMPHOther, specify:
Current Position: / Select positionAssistant ProfessorAssociate ProfessorAdjunt ProfessorVisiting ProfessorProfessorInstructorInvestigators/ResearcherOther, specify:
Institution: / Select academic affiliationUPR Medical Sciences CampusPonce Health Sciences UniversityUniversidad Central del CaribeUPR Comprehensive Cancer CenterUPR Rio Piedras Other, specify:
School: / Select schoolSchool of Dental MedicineSchool of Health ProfessionalsSchool of MedicineSchool of PharmacySchool of Public HealthOther, specify:
Department: / Select departmentBasic Sciences DepartmentClinical Sciences DepartmentEcological Sciences DepartmentEnvironmental HealthEpidemiology and BiostatisticsGraduate DepartmentHealth Services AdministrationHuman DevelopmentPost-doctoral ProgramRestorative Sciences DepartmentSocial SciencesSub Graduate DepartmentSurgical Sciences DepartmentOther, specify:
Program:
Email:
Phone (XXX-XXX-XXXX):
  1. Research Proposal/Grant Description

Please complete the following information:

  1. Tentative Title:

  1. Research Areas:
/ Cardiovascular / HIV
Cancer / Neuroscience
Other, specify:
  1. Research Proposal Grant Purpose:
/ IRB Submission
Funding Application
Other, specify:
  1. Submission for Federal Funding:
/ NIH
Other, specify:
None / Funding Opportunities Announcement (FOA) Number (if applicable):
  1. Submission for Non Federal Funding:
/ Association/Foundation, specify: / Other, specify:
  1. Please provide a study abstract (< 250 words)

  • Background:

  • Aims/Objectives:

  • Hypotheses:

  • Materials and Methods to be used:

  1. Research Proposal/Grant Collaborations

This section is to assess your collaborations in this research proposal/grant. These collaborations include relations/interactions among collaborators (e.g., Co-Investigators, Multiples PI, Co-PI), mentors, consultants, and institutions (e.g., UPR-MSC, PHSU, UCC, others).

In order to document collaborations among PRCTRC investigators, please list all the collaborations related to this study. Do not include collaborations with coordinators, nursing staff, research assistants, or technicians.
Collaborators
(Last Name, First Name) / MULTI-PI/
Co-PI / Institution / Affiliation
1. / SelectMultiple-PICo-PI / SelectUPR Medical Sciences CampusPonce Health Sciences UniversityUniversidad Central del CaribeUPR Comprehensive Cancer CenterUPR Rio Piedras Other, specify:
2. / SelectMultiple-PICo-PI / SelectUPR Medical Sciences CampusPonce Health Sciences UniversityUniversidad Central del CaribeUPR Comprehensive Cancer CenterUPR Rio Piedras Other, specify:
3. / SelectMultiple-PICo-PI / SelectUPR Medical Sciences CampusPonce Health Sciences UniversityUniversidad Central del CaribeUPR Comprehensive Cancer CenterUPR Rio Piedras Other, specify:
4. / SelectMultiple-PICo-PI / SelectUPR Medical Sciences CampusPonce Health Sciences UniversityUniversidad Central del CaribeUPR Comprehensive Cancer CenterUPR Rio Piedras Other, specify:
5. / SelectMultiple-PICo-PI / SelectUPR Medical Sciences CampusPonce Health Sciences UniversityUniversidad Central del CaribeUPR Comprehensive Cancer CenterUPR Rio Piedras Other, specify:
Mentor
(Last Name, First Name) / Institution / Affiliation
1. / SelectUPR Medical Sciences CampusPonce Health Sciences UniversityUniversidad Central del CaribeUPR Comprehensive Cancer CenterUPR Rio Piedras Other, specify:
2. / SelectUPR Medical Sciences CampusPonce Health Sciences UniversityUniversidad Central del CaribeUPR Comprehensive Cancer CenterUPR Rio Piedras Other, specify:
3. / SelectUPR Medical Sciences CampusPonce Health Sciences UniversityUniversidad Central del CaribeUPR Comprehensive Cancer CenterUPR Rio Piedras Other, specify:
Consultants
(Last Name, First Name) / Institution / Affiliation
1. / SelectUPR Medical Sciences CampusPonce Health Sciences UniversityUniversidad Central del CaribeUPR Comprehensive Cancer CenterUPR Rio Piedras Other, specify:
2. / SelectUPR Medical Sciences CampusPonce Health Sciences UniversityUniversidad Central del CaribeUPR Comprehensive Cancer CenterUPR Rio Piedras Other, specify:
3. / SelectUPR Medical Sciences CampusPonce Health Sciences UniversityUniversidad Central del CaribeUPR Comprehensive Cancer CenterUPR Rio Piedras Other, specify:
Will you share any of the following resources with other(s) investigator(s) during this project? (Select all that apply)
1.Biomedical Sample Sharing / No
Yes, please provide investigator(s) name (Last Name, First Name)
2.Research Subjects/Volunteers Sharing: / No
Yes, please provide investigator(s) name (Last Name, First Name)
3.Data/Recorded Information Sharing: / No
Yes, please provide investigator(s) name (Last Name, First Name)
4.Staff Sharing (e.g., coordinators, nursing staff, research assistants, or technicians): / No
Yes, please provide investigator(s) name (Last Name, First Name)
  1. Investigator’s Responsibilities

I,, agree to fulfill the Investigator’s responsibilities and submit the information requested by Puerto Rico Clinical and Translational Research Consortium (PRCTRC).

Please provide an electronic signature.

Date submitted(mm/dd/yyyy):