APPLICATION FORM
3 Pages Only, Exclusive of Attachments
Amended March 7, 2007

SOS Grant Areas: Investigator Initiated Pilot Awards in Clinical and Translational Research Novel Clinical/Translational Methods Catalyst Awards Translational Technology Awards Multidisciplinary/Multicenter Research Project Planning Awards Under-Represented Faculty in Clinical and Translational Research Awards Flexible Mini-Sabbatical/Leave Awards
Project Title:	Amount Requested: $

P.I. Name: Title: Affilation: Email: Box No. Phone:

Co-Investigator: Title: Affilation: Email: Box No. Phone:

Co-Investigator: Title: Affilation: Email: Box No. Phone:

Co-Investigator: Title: Affilation: Email: Box No. Phone:

Co-Investigator: Title: Affilation: Email: Box No. Phone:

Other key personnel

( You may enter up to 300 characters. )

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Research Proposal (description of pilot project or planning activities; for mini-sabbatical/leave award, a full description of proposed activities such as courses to be taken or clinical or laboratory experiences sought where, etc. and project aims for pilot and planning grants)

( You may enter up to 7,500 characters. )

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Other Project Information
For Translational Technology proposals, describe how the new technology will be made available to the wider campus or clinical community.

( You may enter up to 500 characters. )

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References

Timeline and Milestones

( You may enter up to 300 characters. )

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Project Performance/Site Locations

( You may enter up to 300 characters. )

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Human Subjects/Use of Animals/Use of Human Stem Cells

Will human subjects be used: Yes No N/A
If yes, please supply the CHR date of approval and approval number:
Pending

Will animal subjects be used: Yes No N/A
If yes, please supply the CAR date of approval and approval number:
Pending

Will Human Stem Cells be used:  Yes No N/A
If yes, please supply the CHR date of approval and approval number:
Pending

If yes, has this line been approved    Yes No Pending

Budget
($40,000 maximum per proposal except for Translational Technology proposals which can go as high as $75,000)

Proposed Budget	Amount
Salaries (including fringe benefits)
Supplies and Expenses
Equipment
Travel
Animal and Animal Care
Human studies costs
Other: (state)
Total
Future Full Project Funding

Significance

Description of how pilot project will lead to a fully funded multidisciplinary research or education program (including the URL for the RFA and a description of the RFA, if applicable)

( You may enter up to 1,000 characters. )

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Description of how sabbatical will enhance future performance in clinical and translational research (if applicable).

( You may enter up to 1,000 characters. )

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Statement of inclusion in under-represented population group (if applicable).

( You may enter up to 300 characters. )

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Letter of Support
(for all applicants)

Please include a letter from your Department Chair or other Head of Unit with appropriate authority, stating that s/he supports the proposal/leave request and, in the case of Flexible Mini-Sabbatical/Leave Award applicants only, that if an award is made,  that s/he will relieve the applicant of teaching, patient care and other non-research responsibilities during the leave period. This is to be attached as a PDF file and will not be part of the 3 page count.

(upload as PDF file)

Have you applied to non-SOS fund sources for this project?
Yes                   No

If yes, are you willing to give up the other award(s) if you are granted an SOS award?
Yes                   No

Will you permit SOS to explore funding for your project beyond the SOS grant period?
Yes                   No