Following Is the School of Nursing Research and Intramural Funding Program (RIFP) Schedule

Small Pilot Grant Application

Institute of Translational Health Sciences

**Required format: Margins: .50; Font: Arial 11 pt regular**

Application Title:

Project Summary: In the space below, summarize the specific aims, the research design, and methods for achieving the stated goals, using language that is understandable to a scientifically or technically literate reader not in your field.

Relevance:Using no more than two or three sentences, describe the relevance of this research to public health. In this section, be succinct and use plain language that can be understood by a general, lay audience.

Keywords: Please provide 3-7 MeSH keywords that best describe the areas of expertise necessary to provide a good review of your proposal. See for a browseable hierarchy of MeSH terms.

Principal Investigator:

Academic Rank:

Department:

Telephone # & Email Address:

Street Address:

Institution Name:

City State Zip:

Co-Investigator(s) Names and Institutions:

Human Subjects Approval Required? ____YES ____ NO

If YES, has application been submitted? ____YES ____NO

(Please note: IRB approval is not required until the project has been selected)

Institutional Animal Care and Use Committee (IACUC) Approval Required? ____YES ____ NO

If YES, has application been submitted? ____YES ____ NO

(Please note: IACUC approval is not required until the project has been selected)

I am applying for (check one):

Dissemination/Implementation Pilot _____ YES ______NO

______Small Pilot, $10,000 only

______Small Pilot, $10,000 plus core services

Note—Original or electronic signatures are required

Date: ______

PI SignatureDepartment Chair Signature

______

Aims, Significance, and Methods(limit—5 pages)

Include the following sections:

Introduction--response to prior critiques (include this section only if this is a resubmission. Limit is ½ extra page, for 5-1/2 pages total)

Specific Aims

Significance (Note—include significance in relation to translational health science)

Innovation

Research Approach

Future Plans (Explain how pilot funding will be used for conducting research activities designed to prepare and support full-scale clinical or translational research).

Timetable(limit—1/2 page)

Include timetable for development of work.

References(limit—2 pages)

Budget

**Guidelines for FHCRC and Seattle Children’s**

Fred Hutchinson Cancer Research Center and Seattle Children’s Research Institute have agreed to consider requests for indirect cost waivers for ITHS pilot awards from their faculty.

ITHS members whose research program is based at Fred Hutchinson Cancer Research Center, who wish to apply for ITHS pilot awards are required to go through the standard institutional procedure for requesting a waiver of facilities and administrative (F&A) costs, as described on the FHCRC Web site: (

ITHS members whose research program is based at Seattle Children’s Research Institute, who wish to apply for ITHS pilot awards are required to go through the standard institutional procedure for requesting a waiver of facilities and administrative (F&A) costs, as described on the SCRI Web site:

If you are a Seattle Children’s or FHCRC Researcher please indicate if you have received approval to waive Indirect costs. YES NO

Complete this only if you are not at UW, Seattle Children’s or FHCRC:

Name of institutional official to contact about your subcontract in the event you are funded: ______(this will help get your funds to you)

Email address: ______

Phone: ______

If you are outside of UW, a subcontract will be put in place to award your funds. Due to our award cycle and the complexity of subcontracts, receipt of your funds can take about 2-3 months. Having the contact information for your institutional official in charge of awards is an important step for us to help you get your award as soon as possible. Please note that if this process gives you a late start, you still have the opportunity to request an extension for your award at a later date.

Budget—ITHS Core Services (leave blank if none requested)

Note—See list of possible ITHS services on the next page.

TOTAL—Direct Costs plus ITHS Services: $______

ITHS Services That May Be Requested

Budget Justification(limit—1 page)

Detail expenses listed above and explain how funds will be used. If other sources of funding are being combined with this award to carry out the proposed research, it is critical to address the ways in which the other funding will be used to complete the study or complement the ITHS award.

Biosketch

Use NIH Biosketch form for PI and each Co-PI. Limit—4 pages for each.

Reviewers

Provide the names and contact information (email address, phone, institution, department) for at least 3 possible reviewers who would be qualified to provide a review of your application. These nominations should be limited to researchers in the Puget Sound or WWAMI region.

A general note about conflict of interest in asking people to review:

A reviewer would have a conflict of interest if they are the applicant's mentor, dept.chair, spouse, or close relative; or if they currently work together on manuscripts, grants, or business ventures. Simplybeing in the same department or Division is not, in and of itself, a conflict of interest.

Appendix (Optional)

Include additional materials, instruments, etc. Avoid lengthy appendices.