BARNES-JEWISH HOSPITAL FOUNDATION



|2017 SPIRiT Collaboration Application |

|TITLE OF PROJECT:       |

|PROJECT PERIOD (1 YEAR): 07/01/2017-06/30/2018 |

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|CONTACT/SITE PI NAME (Last, First): |DEGREE(S): |FUNDS REQUESTED: |

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|POSITION TITLE: |SPIRiT APPLICANT ORGANIZATION: |

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|TELEPHONE (Area code/number): |DEPARTMENT: |

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|EMAIL ADDRESS: |DIVISION: |

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|SITE PI NAME (Last, First): |DEGREE(S): |FUNDS REQUESTED: |

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|POSITION TITLE: |SPIRiT APPLICANT ORGANIZATION: |

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|TELEPHONE (Area code/number): |DEPARTMENT: |

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|EMAIL ADDRESS: |DIVISION: |

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|SITE PI NAME (Last, First): |DEGREE(S): |FUNDS REQUESTED: |

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|POSITION TITLE: |SPIRiT APPLICANT ORGANIZATION: |

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|TELEPHONE (Area code/number): |DEPARTMENT: |

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|EMAIL ADDRESS: |DIVISION: |

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|SITE PI NAME (Last, First): |DEGREE(S): |FUNDS REQUESTED: |

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|POSITION TITLE: |SPIRiT APPLICANT ORGANIZATION: |

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|TELEPHONE (Area code/number): |DEPARTMENT: |

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|EMAIL ADDRESS: |DIVISION: |

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|SITE PI NAME (Last, First): |DEGREE(S): |FUNDS REQUESTED: |

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|POSITION TITLE: |SPIRiT APPLICANT ORGANIZATION: |

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|TELEPHONE (Area code/number): |DEPARTMENT: |

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|EMAIL ADDRESS: |DIVISION: |

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|SITE PI NAME (Last, First): |DEGREE(S): |FUNDS REQUESTED: |

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|POSITION TITLE: |SPIRiT APPLICANT ORGANIZATION: |

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|TELEPHONE (Area code/number): |DEPARTMENT: |

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|EMAIL ADDRESS: |DIVISION: |

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SPIRiT Face Page 3/2017 Form Page 1

|Contact Principal Investigator (Last, First, Middle):       |

|ABSTRACT (150 words or less) |

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|IMPACT |

|Summarize the significance and innovation of this collaborative project (importance of the problem in clinical and/or translational research, exploration of |

|novel and potentially transformative concepts, commercial potential) to develop high impact research which has the potential to promote the translation of |

|scientific discoveries into improvements in human health? |

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SPIRiT Abstract Page 3/2017 Form Page 2

|Contact Principal Investigator (Last, First, Middle):       |

|PROJECT PERFORMANCE SITES(s) and SHORT DESCRIPTION OF RESOURCES |

|Regarding each participating SPIRiT site, indicate where the work described in the Research Plan will be conducted and briefly describe the specifically |

|required resources that will be used to carry out the proposed project. |

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SPIRiT Resources Page 3/2017 Form Page 3

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