Part Two Table of Contents – Form 7
Applicant Organization
PI Last Name, First Name
Form
1
Form Name
Page
Face Page ............................................................................................................1
1-S
Face Page - Subcontracting Organization(s)* ........................................................
2
Staff, Collaborators, Consultants and Contributors ................................................
3
Independent Oversight Panel ................................................................................
4
Acronyms and Abbreviations Used in Application .................................................
5
Lay Abstract (do not exceed 300 words) ...................................................................
6
Scientific Abstract (do not exceed 1 page)................................................................
7
Table of Contents ..................................................................................................
8
Budget and Justification - Applicant ......................................................................
8
Budget and Justification – Subapplicant Organization(s)* .....................................
9
Biographical Sketch(es) (do not exceed 3 pages each) .............................................
10
Facilities and Resources (do not exceed 2 pages each) ............................................
11
Other Research Support .......................................................................................
12
Introduction (do not exceed 3 pages)* ......................................................................
13
Workplan (do not exceed 35 pages for sections a-c) ...................................................
Summary and Detail .......................................................................................
a. Significance ................................................................................................
b. Background and Preliminary Results .........................................................
c. Research and Development Plan ..............................................................
d. Milestones and Timeline ............................................................................
e. Project Management and Coordination Strategy ........................................
f. Literature Cited............................................................................................
14
Human Subjects – at least one for each applicant and sub-applicant ...........................
15
Vertebrate Animals – at least one for each applicant and sub-applicant .......................
16
Human Stem Cells – at least one for each applicant and sub-applicant .......................
Appendix Material .................................................................................................
*
Indicate “N/A” if not applicable.
1
Part Two Biographical Sketch – Form 9
NAME
POSITION/TITLE
EDUCATION/TRAINING (Begin with baccalaureate or other professional education, and include postdoctoral
training)
ORGANIZATION AND LOCATION
DEGREE
YEAR(s)
FIELD OF STUDY
A. Personal Statement.
B. Positions and Honors.
C. Selected peer-reviewed publications or manuscripts in press (in chronological order) from a total
of ______.
2
Part Two Facilities and Resources – Form 10
Laboratory:
Clinical:
Animal:
Computer:
Office:
Other:
MAJOR EQUIPMENT:
3
Part Two Other Support – Form 11
NAME OF KEY PERSONNEL:
Check here if this person has no other source of Active or Pending support:
TITLE OF PROJECT:
Check here to indicate whether this support is Active or Pending:
BRIEF PROJECT DESCRIPTION:
NAME OF PROJECT PI:
FUNDING AGENCY:
AWARD # (e.g., NIH 5R01GM000000-01):
PERIOD OF SUPPORT (Start and End Dates):
PROFESSIONAL EFFORT:
%
ACTIVE
PENDING
-
THIS PROJECT INVOLVES STEM CELL RESEARCH:
*YES
NO
*For any “Yes” answer, list the specific aims of the project and explain the distinction
between the project and this NYS-funded contract.
THIS PROJECT OVERLAPS A RESEARCH AIM OR A BUDGETARY ITEM IN THE APPLICATION:
**YES
NO
**For any “Yes” answer, provide the intended resolution if the project is funded.
4
Part Two Introduction – Form 12
5
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[]
Part Two WORK PLAN – Form 13
SUMMARY
PROJECT NAME:
________________________________________
CONTRACTOR SFS PAYEE NAME:
________________________________________
CONTRACT PERIOD:
From: ___________________
To:
___________________
Provide an overview of the project including goals, tasks, desired outcomes and performance measures:
6
Part Two WORK PLAN – Form 13
DETAIL
OBJECTIVE
1:
BUDGET
CATEGORY/
DELIVERABLE
(if applicable)
TASKS
a.
PERFORMANCE MEASURES
i.
ii.
iii.
b.
i.
ii.
iii.
c.
i.
ii.
iii.
7
Part Two WORK PLAN – Form 13
DETAIL
OBJECTIVE
2:
BUDGET
CATEGORY/
DELIVERABLE
(if applicable)
TASKS
a.
PERFORMANCE MEASURES
i.
ii.
iii.
b.
i.
ii.
iii.
c.
i.
ii.
iii.
8
Part Two WORK PLAN – Form 13
DETAIL
OBJECTIVE
3:
BUDGET
CATEGORY/
DELIVERABLE
(if applicable)
TASKS
a.
PERFORMANCE MEASURES
i.
ii.
iii.
b.
i.
ii.
iii.
c.
i.
ii.
iii.
9
Part Two Workplan – Form 13 – Narrative Parts a-f
10
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Part Two Human Subjects – Form 14
SECTION A:
1. Applicant/Sub-applicant Organization:
2. Are Human Subjects involved?
Yes
No
3. Is the project Exempt from federal regulations?
Yes
4. If YES to #3, what is the Exemption number?
1
5. If NO to #3, is the IRB review Pending?
No
2
3
Yes
6. IRB Approval Date (leave blank only if Yes to #5):
7. IRB Protocol Approval Number:
8. OHRP Federal-wide Assurance Number:
SECTION B – NARRATIVE (use additional pages if necessary):
11
4
5
No
6
Part Two Vertebrate Animals – Form 15
SECTION A:
1. Applicant/Sub-applicant Organization:
2. Are Vertebrate Animals involved?
3. Is the IACUC review Pending?
Yes
Yes
No
4. IACUC Approval Date (leave blank only if YES to #3):
5. IACUC Protocol Approval Number:
6. Animal Welfare (OLAW) Assurance Number:
7. USDA Registration Number (if applicable to species):
SECTION B – NARRATIVE (use additional pages if necessary):
12
No
Part Two Human Stem Cells – Form 16
SECTION A:
1. Applicant/Sub-applicant Organization:
2. Are Human Stem Cells involved?
Yes
No
3. Is the project Exempt under NAS or ISSCR?
Yes
No
4. If YES to #3, check the appropriate exemption:
5. If NO to #3, is the SCRO review pending?
NAS 1.3(a)
Yes
6. SCRO Approval Date (leave blank only if YES to #5):
7. SCRO Protocol Approval Number:
SECTION B – NARRATIVE (use additional pages if necessary):
13
No
ISSCR Category 1