Location via proxy:   [ UP ]  
[Report a bug]   [Manage cookies]                
Scribd Logo
Upload

Welcome to Scribd!

  • 23 views

    Grant Application: Do Not Exceed 56-Character Length Restrictions, Including Spaces

    Uploaded by

    NEKRO
    This document appears to be a grant application form requesting basic information such as the title of the project, principal investigator details, dates for the proposed project period, requested funding amounts, and assurances that the information provided is true. It requests information on whether the project involves human subjects research, vertebrate animals, and institutional approval if needed. Signatures are required from the principal investigator and institutional official to certify the accuracy of the information and accept terms if a grant is awarded.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd

    Grant Application: Do Not Exceed 56-Character Length Restrictions, Including Spaces

    Uploaded by

    NEKRO
    23 views1 page
    This document appears to be a grant application form requesting basic information such as the title of the project, principal investigator details, dates for the proposed project period, requested funding amounts, and assurances that the information provided is true. It requests information on whether the project involves human subjects research, vertebrate animals, and institutional approval if needed. Signatures are required from the principal investigator and institutional official to certify the accuracy of the information and accept terms if a grant is awarded.

    Original Description:

    Grant

    Original Title

    Grant

    Copyright

    © © All Rights Reserved

    Available Formats

    PDF, TXT or read online from Scribd

    Did you find this document useful?

    Is this content inappropriate?

    This document appears to be a grant application form requesting basic information such as the title of the project, principal investigator details, dates for the proposed project period, requested funding amounts, and assurances that the information provided is true. It requests information on whether the project involves human subjects research, vertebrate animals, and institutional approval if needed. Signatures are required from the principal investigator and institutional official to certify the accuracy of the information and accept terms if a grant is awarded.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    23 views1 page

    Grant Application: Do Not Exceed 56-Character Length Restrictions, Including Spaces

    Uploaded by

    NEKRO
    This document appears to be a grant application form requesting basic information such as the title of the project, principal investigator details, dates for the proposed project period, requested funding amounts, and assurances that the information provided is true. It requests information on whether the project involves human subjects research, vertebrate animals, and institutional approval if needed. Signatures are required from the principal investigator and institutional official to certify the accuracy of the information and accept terms if a grant is awarded.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    of 1

    "Form Approved Through 05/2004 OMB No.

    0925-0001

    Department of Health and Human Services LEAVE BLANK—FOR PHS USE ONLY.
    Public Health Services Type Activity Number
    Review Group Formerly
    Grant Application
    Do not exceed 56-character length restrictions, including spaces. Council/Board (Month, Year) Date Received
    1. TITLE OF PROJECT

    2. RESPONSE TO SPECIFIC REQUEST FOR APPLICATIONS OR PROGRAM ANNOUNCEMENT OR SOLICITATION NO YES


    (If “Yes,” state number and title)
    Number: Title:
    3. PRINCIPAL INVESTIGATOR/PROGRAM DIRECTOR New Investigator No Yes
    3a. NAME (Last, first, middle) 3b. DEGREE(S)

    3c. POSITION TITLE 3d. MAILING ADDRESS (Street, city, state, zip code)

    3e. DEPARTMENT, SERVICE, LABORATORY, OR EQUIVALENT

    3f. MAJOR SUBDIVISION

    3g. TELEPHONE AND FAX (Area code, number and extension) E-MAIL ADDRESS:
    TEL: FAX:
    4. HUMAN SUBJECTS 4a. Research Exempt No Yes 5. VERTEBRATE ANIMALS No Yes
    RESEARCH
    If “Yes,” Exemption No.
    No 4b. Human Subjects 4c. NIH-defined Phase III 5a. If “Yes,” IACUC approval Date 5b. Animal welfare assurance no
    Assurance No. Clinical Trial
    Yes
    No Yes
    6. DATES OF PROPOSED PERIOD OF 7. COSTS REQUESTED FOR INITIAL 8. COSTS REQUESTED FOR PROPOSED
    SUPPORT (month, day, year—MM/DD/YY) BUDGET PERIOD PERIOD OF SUPPORT
    From Through 7a. Direct Costs ($) 7b. Total Costs ($) 8a. Direct Costs ($) 8b. Total Costs ($)

    9. APPLICANT ORGANIZATION 10. TYPE OF ORGANIZATION


    Name Public: → Federal State Local
    Address Private: → Private Nonprofit
    For-profit: → General Small Business
    Woman-owned Socially and Economically Disadvantaged
    11. ENTITY IDENTIFICATION NUMBER

    DUNS NO. (if available)


    Institutional Profile File Number (if known) Congressional District
    12. ADMINISTRATIVE OFFICIAL TO BE NOTIFIED IF AWARD IS MADE 13. OFFICIAL SIGNING FOR APPLICANT ORGANIZATION
    Name Name
    Title Title
    Address Address

    Tel FAX Tel FAX


    E-Mail E-Mail
    14. PRINCIPAL INVESTIGATOR/PROGRAM DIRECTOR ASSURANCE: I certify that the SIGNATURE OF PI/PD NAMED IN 3a. DATE
    statements herein are true, complete and accurate to the best of my knowledge. I am (In ink. “Per” signature not acceptable.)
    aware that any false, fictitious, or fraudulent statements or claims may subject me to
    criminal, civil, or administrative penalties. I agree to accept responsibility for the scientific
    conduct of the project and to provide the required progress reports if a grant is awarded as
    a result of this application.
    15. APPLICANT ORGANIZATION CERTIFICATION AND ACCEPTANCE: I certify that the SIGNATURE OF OFFICIAL NAMED IN 13. DATE
    statements herein are true, complete and accurate to the best of my knowledge, and (In ink. “Per” signature not acceptable.)
    accept the obligation to comply with Public Health Services terms and conditions if a grant
    is awarded as a result of this application. I am aware that any false, fictitious, or fraudulent
    statements or claims may subject me to criminal, civil, or administrative penalties.
    PHS 398 (Rev. 05/01) Face Page Form Page 1

    You might also like