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fLaQYiIUUWPnnFg8PR8vyWKoeexGExSgNhY6IMJeDGiSatY

COVID-19 Pilot Research Application

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GENERAL INFORMATION:

The overall mission of the Translational Research Development Program is to "Increase the translation of health sciences research and health care delivery to the people of Indiana and beyond by facilitating an environment that enables the conduct of clinical and translational science research.”

Indiana Biobank applicants: Whether you are requesting samples and/or pilot funding, please complete the application below.

POST AWARD REQUIREMENTS:

1. All awards will be expected to go through a brief assessment of milestones and progress on a 6-month interval [reminder will come from the PDT Administrative Office] while the project is active; once the project is complete, follow-up will continue annually for 5 years.

2. In keeping with standard practices when grant recipients’ work is funded or published, investigators are reminded to acknowledge receipt of the CTSI support in any presentation or publication by acknowledging grant UL1TR002529.

If you have any questions, please contact Lane Coffee at 317.278.2150 or rlcoffee@iu.edu.

Last Name

* must provide value

First Name

* must provide value

What degree(s) have you received?

* must provide value

PhD

DDS

DNS

MBA

MPH

DVM

PharmD

PI email address

* must provide value

What is your primary institution affiliation?

* must provide value

Other, please explain.

* must provide value

What is your campus location?

* must provide value

Other, please explain.

* must provide value

Department

* must provide value

School

* must provide value

Faculty Rank

* must provide value

Years at Rank

* must provide value

Investigator Expertise (minimum 3 keywords)

* must provide value

eRA commons name

* must provide value

Other Key Personnel
Include their role, school affiliation, dept, and rank

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Protocol Title

* must provide value

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Translational Stage & Phase Worksheet
(to be utilized in questions below)

Attachment:Translational Stages-Phases Worksheet.pdf

Utilizing the Translational Stage-Phase Worksheet (above), please describe:

The current STAGE and PHASE of your project

* must provide value

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Utilizing the Translational Stage-Phase Worksheet (above), please describe:

The next STAGE and PHASE that your project will follow after conducting the research proposed in this application

* must provide value

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Proposal Template

Attachment:PDT Proposal Format.docx

Please Upload Proposal Utilizing Template Above

* must provide value

Upload file

Are you seeking Indiana Biobank COVID-19 samples?

* must provide value

Yes

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Sample Type(s) Requested

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DNA

Plasma

RNA

PBMCs

Urine

Serum

Other

Other Type

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If applying for pilot funding, please upload a budget & budget justification for your project.

NOTE: PI salaries and travel are not allowable expenses.

Upload file

Key Personnel NIH Biosketch(es)

NOTE: Please combine into one PDF if multiple Biosketches.

* must provide value

Upload file

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