TRIresearchproposal0708



Cincinnati Children's Hospital Medical CenterDepartment of Patient ServicesIn collaboration with The University of CincinnatiCenter for Clinical and Translational Science and TrainingPS2 Research Scholars Program in Patient ServicesGrant Application & Instructions 2016DEADLINESLetters of Intent: May 17, 2016 by 5:00pmInvitation to submit full proposal: June 1, 2016Applications: July 19, 2016 by 5:00pmNotification of Awards: September 1, 2016Funds available: October 1, 2016For questions regarding these instructions, please contact Scott K. Holland, PhD, Director: Research in Patient Services at 513-803-4544 or by email at: PS2.Application@Deadlines: Deadlines for submissions are firm, without exceptions other than 1) death in the PI's immediate family, 2) acute severe illness of the PI, or 3) a natural disaster.Invited applications must be submitted electronically (the letter of support may be submitted either on paper or electronically as a PDF file with signatures). Send a PDF file of the assembled application to PS2.Application@ by 5 PM Friday, July 19, 2016.2) Background: The Department of Patient Services in collaboration with the Center for Clinical and Translational Science and Training (CCTST) supported by the NIH Clinical and Translational Sciences Award (CTSA), has established a Research Scholars Program for scientists in nursing and the allied health professions at CCHMC. Integral to the mission of the CCTST is to train selected junior faculty members in the Academic Health Center (AHC) to conduct clinical and translational research. The PS2 Research Scholars Program in Patient Services parallels the KL2 Research Scholars Program of the CTSA and represents a career step between completion of the PhD and readiness for application for grants from the NIH such as K01, K08, and K25, and R01. The PS2 program targets nursing and allied health professionals employed in the Department of Patient Services at CCHMC and will support doctoral level scientists with nursing and allied health backgrounds who aim to focus their career on research. At least 75% of the Scholars’ full-time professional effort must be devoted to the PS2 plan for its duration. The PS2 is designed to support additional mentored research training for clinical health professionals who have already completed the PhD but who need additional training prior to achieving independence in the academic research setting. The primary goal of the PS2 grant award mechanism is to provide protected time for research career development for a period of 2-3 years, under the guidance of an established research mentor, in order to obtain the training and improve the publication record needed to compete successfully for extramural grant funding. The program will provide salary support for 75% effort of the Scholar during this 2-year period along with mentorship and specific expectations for publications and applications for extramural grants. A 3rd year of support is also possible with demonstrated productivity.3) Definitions of Translation and Clinical Research eligible for support by the PS2 award mechanism: Translational research occurs at four levels:Translation 1 (T1): from basic science to health application and includes clinical researchClinical research encompasses 3 areas:i.Patient-oriented research. Research conducted with human subjects (or on material of human origin such as tissues, specimens and cognitive phenomena) for which an investigator (or colleague) directly interacts with human subjects. Patient-oriented research includes: (a) mechanisms of human disease, (b) therapeutic interventions, (c) clinical trials, or (d) development of new technologies. ii.Epidemiologic and behavioral studies.iii.Outcomes research and health services research.Translation 2 (T2): from health application to evidence-based guidelineTranslation 3 (T3): from evidence-based guideline to health practiceTranslation 4 (T4): from health practice to health impact in the populationFor more details consult the NIH website at: of Grants Available: New research proposals: These grants are for 3 years of support, contingent on sufficient progress during the first 2 years. First year funds will be available October 1, 2016 and will need to be spent prior to September 30, 2017. 2nd and 3rd year renewal applications: Applications for second and third year support must include a “Progress to Date” section demonstrating progress in career development and research and progress towards applying for an individual K award or R award. Progress reports/continuing applications should be submitted by July 15, 2017. A third year of support will be granted with evidence of sufficient progress in the first 2 years but 3rd year applications will also have to compete for funding against new applicants. Eligibility: To be eligible, the applicant must be a full-time employee of Cincinnati Children’s Hospital Medical Center (CCHMC) and have a faculty appointment at the University of Cincinnati (UC) or another accredited institution at the time of the application. Faculty appointment cannot be contingent upon obtaining the PS2 award. The applicant must also be a U.S. citizen or have permanent resident status.? Faculty researchers who have been a principal investigator on an R01 or?on another K award, or project leader on a P01 or P50, or their equivalents, are not eligible.? Those who have been a PI on an R03 or R21 award are still eligible. CCHMC Procter Scholars and Trustee Grant recipients are ineligible. PS2 applicants may not have any other career development award (e.g., K08, K01, K23) pending at any time during the review process. CCTST membership is required prior to submitting the Letter of Intent (LOI). To join the CCTST free of charge, go to . Overview of Review Process: The review of applications is performed in 3 phases: (1) Letters of Intent (LOI), (2) Scientific Review, and (3) Administrative Review. During the 1st phase, the 1-2 page LOIs will be submitted for review to determine the number of review panelists needed and range of expertise required as well as to determine the eligibility of the applicants. During the 2nd phase, the 12-page applications will be reviewed by 2-3 scientific reviewer who will score the applications following CCTST KL2 program guidelines. The PS2 proposals will be reviewed according to the same criteria as the KL2. The 1-9 point scoring system used for the PS2 proposals is based on the current NIH scoring rubric for K-grants and can be found on the NIH website at: . In the final phase, proposals, critiques and scores will be reviewed by Patient Services Research Administration for consistency with programmatic goals and institutional strategic plans.Specific funding is earmarked for the PS2 program during each cycle to insure that high quality PS2 proposals will be funded. During the third and final phase, applicant scores will be tabulated and ranked, and PS2 program leaders will discuss and determine awardees. Critiques from the second phase of the review will be provided to the applicants after awards are announced.Letter of intent: The LOI consists of the application face page plus, 1 page outlining the applicant’s career development and research objectives and NIH format Biosketch. No supplemental material will be accepted for the LOI. All LOI applications must be submitted by email to <PS2.Application@>. The LOI must be received by 5 pm on Friday, May 17, 2016. Signatures: For the Letters of Intent and applications, the signature of the investigator and his/her respective division director or departmental chairperson(s) are required. Letters of Support: Applications must include letters of support from (1) the applicant’s primary mentor and (2) division director or department chairperson. Included in the letters of support must be a statement regarding the priority of the research proposal for the division or department and a guarantee of at least 75% protected time for research and career development.Mentor Requirements: Primary PS2 mentors should meet the following criteria: at least $300,000 in annual grant support for clinical or translational research, a strong record of mentorship, and protected time for mentorship. Mentors not included in the CCTST Cadre of Mentors must be approved before submission by contacting the program director at PS2.Application@. A list of mentors meeting those criteria is available at . Additional mentors or advisors from others institutions may also be included on the mentorship committee to complement expertise of the primary mentor to fill specific gaps in the candidate’s training.Mentors are strongly encouraged to participate in the CCTST’s mentor training program, an 8-hour program (four 2-hour sessions held periodically) covering the following competencies: maintaining effective communication; aligning expectations; assessing understanding; addressing equity and inclusion; fostering independence; and promoting professional development. Furthermore, PS2 applicants and their proposed mentors are strongly encouraged to submit with the PS2 application a written mentoring agreement/individual development plan specifying: (1) the applicant’s planned research activities (planned abstracts, papers, grant applications); (2) planned educational activities; (3) planned professional/career development activities (e.g., skills development, progress towards promotion, networking, work-life balance, plans for independence from mentor); (4) support for the applicant (protected time, resources, advocacy, emotional support); (5) communication (e.g., frequency and structure of meetings, progress reports, feedback, confidentiality); and 6) personal conduct/interpersonal relationships (e.g., plans for managing conflicts, authorship order) [see sample Mentorship Agreement Template and sample Individual Development Plans below]. Mentorship agreements and associated individual development plans may be included in an appendix and do not count against the 12-page application limit. Budget Guidelines: The award provides up to 3 years of funding to cover 75% effort for the PI. This will include up to $75,000 direct costs salary support of the PI. In addition to direct salary costs, associated fringe benefits will also be covered by the award. $25,000 for research-related expenses is also provided by the award. Allowable research-related expenses include: (a) tuition and fees related to career development; (b) research expenses, such as supplies, statistical data analysis, equipment and technical personnel (total cost); (c) travel to research meetings, workshops, or training; and (d) statistical services including personnel (total cost) and computer time. Applicants must allow $1,500 for travel to the annual Association for Clinical Research Training (ACRT)/ Society for Clinical and Translational Science (SCTS) joint annual meeting. Facilities and administrative (F&A) costs, as well as salaries for mentors, secretarial and administrative staff, etc. are not allowed as part of the PS2 Program.Application forms (modified from PHS 398) are attached or may be downloaded from the CCTST website.Applications must be submitted in single-spaced text, one-half inch margins, and no smaller than an 11-point font. Arial or Helvetica typefaces are preferred. The primary applicant’s name must appear in the upper right hand corner of each page. Applications are limited to 13 pages (career development plan = 4 pages, research plan = 8 pages, specific aims & hypotheses = 1 page), including figures but excluding animals and human subjects protection and references. Standard PHS 398 forms for budget, biosketch, and other support should be position of PS2 application for both new scholar research proposals and competing renewals. See following forms. Create files that are labeled with appropriate parts.File #1 Application and grant proposalFace page (check all appropriate IBC, IACUC, IRB, or Radiation Safety approvals or indicate pending if submitted)Abstracts Scientific 200 wordsLay person description 100 wordsDetailed Budget (2 years; use PHS 398 form provided, 3rd year will be requested at time or continuation application)Budget JustificationBiosketch(es) (include PI and primary mentor; use PHS 398 form, 5-page limit for each in 2016 format)Other support (PHS 398 form)Included in the 13-page limit for the application Career Development Plan (suggested 4 pages)Candidate’s BackgroundCareer Goals and ObjectivesCareer Development/Training Activities During Award PeriodTraining in the Responsible Conduct of Research (not included in the 4 page limit)Mentoring PlanPlanned publication scheduleGrant application plans and timelineResearch Strategy (suggested 9 pages)Hypotheses and Specific Aims (1 page required)Significance (suggested 1 page)InnovationPreliminary Results or, for 2nd & 3rd year renewal, Progress ReportApproachFacilities and other Resources Available for the Project (no page limit)Statement of how the research is translational (1 page recommended)Statements regarding human subjects and/or animals Literature citedDiversity questionnaire - see form Checklist-see formMentoring agreement/individual development plan (optional but encouraged)File #2 Letters of supportLetter of support from division director or department chairpersonLetters of support from collaborators or consultants, and/or letters of access from core directors, etc.University of Cincinnati PS2 Grant ProgramGrant Application1.TITLE OF PROJECT (Do not exceed 56 characters, including spaces and punctuation.) FORMTEXT ?????1a.Type of application: FORMCHECKBOX New Application FORMCHECKBOX Renewal Application2. PRINCIPAL INVESTIGATOR/PROGRAM DIRECTOR New CCTST Investigator FORMCHECKBOX No FORMCHECKBOX Yes2a.NAME (Last, first, middle) FORMTEXT ?????2b.DEGREE(S) FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????2c.POSITION TITLE FORMTEXT ?????2d.MAILING ADDRESS (Street, city, state, zip code) FORMTEXT ?????2e.DIVISION FORMTEXT ?????2f.DEPARTMENT, SERVICE, LABORATORY, OR EQUIVALENT FORMTEXT ?????2g.TELEPHONE AND FAX (Area code, number and extension)E-MAIL ADDRESS:TEL: FORMTEXT ?????FAX: FORMTEXT ????? FORMTEXT ?????3. PRIMARY MENTOR3a.NAME (Last, first, middle) FORMTEXT ?????3b.DEGREE(S) FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????3c.POSITION TITLE3d.MAILING ADDRESS (Street, city, state, zip code) FORMTEXT ?????3e.DIVISION FORMTEXT ?????3f.DEPARTMENT, SERVICE, LABORATORY, OR EQUIVALENT FORMTEXT ?????3g.TELEPHONE AND FAX (Area code, number and extension)E-MAIL ADDRESS:TEL: FORMTEXT ?????FAX: FORMTEXT ????? FORMTEXT ?????4.Human Subjects Research FORMCHECKBOX No FORMCHECKBOX Yes4a.Research Exempt FORMCHECKBOX No FORMCHECKBOX YesIf “Yes,” Exemption No. FORMTEXT ?????4b.Human Subjects Assurance No.4c.NIH-Defined Phase I Clinical Trial FORMCHECKBOX No FORMCHECKBOX Yes5. Human Subjects Protection Certification: FORMCHECKBOX No FORMCHECKBOX Yes5a.Certification Date: FORMTEXT ?????6.Vertebrate Animals FORMCHECKBOX No FORMCHECKBOX Yes6a.If “Yes,” IACUC Approval Date FORMTEXT ?????6b.Animal Welfare Assurance No. FORMTEXT ?????7.IBC Protocol FORMCHECKBOX No FORMCHECKBOX Yes7a.If “Yes,” Approval Date: FORMTEXT ?????7b.Approval Number: FORMTEXT ?????8.Radiation FORMCHECKBOX No FORMCHECKBOX Yes8a.If “Yes,” Approval Date FORMTEXT ?????9.DATES OF PROPOSED PERIOD OF SUPPORT (month, day, year—MM/DD/YY)COSTS REQUESTEDDirect Costs ($) FORMTEXT ?????FromThrough10/01/1609/30/1712.The undersigned reviewed this application for a PS2 research award and are familiar with the policies, terms, and conditions concerning research support and accept the obligation to comply with all such policies, terms, and conditions.Primary Applicant: FORMTEXT ?????Division Chair of Primary Applicant: FORMTEXT ?????Signature of Primary ApplicantDate:Signature of Division Chair of Primary ApplicantDate:Principal Investigator/Program Director (Last, First, Middle): FORMTEXT ?????Scientific Abstract: Using technical language, briefly describe the proposed project in 200 words or less. FORMTEXT ?????Lay Abstract: Using non-technical language, briefly describe the proposed project in 100 words or less. FORMTEXT ?????Principal Investigator/Program Director (Last, First, Middle): FORMTEXT ?????DETAILED BUDGET FOR BUDGET PERIODDIRECT COSTS ONLYFROMTHROUGH10/01/1609/30/17PERSONNEL (Applicant organization only)%DOLLAR AMOUNT REQUESTED (omit cents)NAMEROLE ONPROJECTTYPEAPPT.(months)EFFORTONPROJ.INST.BASESALARYSALARYREQUESTED (75% up to 75,000)FRINGEBENEFITSTOTAL FORMTEXT ?????PS2 Scholar1275% FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????274320016891000SUBTOTALS FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????CONSULTANT COSTS FORMTEXT ?????EQUIPMENT (Itemize) FORMTEXT ????? FORMTEXT ?????SUPPLIES (Itemize by category) FORMTEXT ????? FORMTEXT ?????TRAVEL FORMTEXT ?????PATIENT CARE COSTSINPATIENT FORMTEXT ????? FORMTEXT ?????OUTPATIENT FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????OTHER EXPENSES (Itemize by category) FORMTEXT ????? FORMTEXT ?????SUBTOTAL DIRECT COSTS FOR INITIAL BUDGET PERIOD$ FORMTEXT ?????CONSORTIUM/CONTRACTUAL COSTSDIRECT COSTS FORMTEXT ?????FACILITIES AND ADMINISTRATIVE COSTSN/A502920017526000TOTAL DIRECT COSTS FOR INITIAL BUDGET PERIOD (Item 10, Face Page)$ FORMTEXT ?????Principal Investigator/Program Director (Last, First, Middle): FORMTEXT ?????DETAILED BUDGET FOR BUDGET PERIODDIRECT COSTS ONLYFROMTHROUGH10/01/1609/30/17PERSONNEL (Applicant organization only)%DOLLAR AMOUNT REQUESTED (omit cents)NAMEROLE ONPROJECTTYPEAPPT.(months)EFFORTONPROJ.INST.BASESALARYSALARYREQUESTED (75% up to 75,000)FRINGEBENEFITSTOTAL FORMTEXT ?????PS2 Scholar1275% FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????274320016891000SUBTOTALS FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????CONSULTANT COSTS FORMTEXT ?????EQUIPMENT (Itemize) FORMTEXT ????? FORMTEXT ?????SUPPLIES (Itemize by category) FORMTEXT ????? FORMTEXT ?????TRAVEL FORMTEXT ?????PATIENT CARE COSTSINPATIENT FORMTEXT ????? FORMTEXT ?????OUTPATIENT FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????OTHER EXPENSES (Itemize by category) FORMTEXT ????? FORMTEXT ?????SUBTOTAL DIRECT COSTS FOR INITIAL BUDGET PERIOD$ FORMTEXT ?????CONSORTIUM/CONTRACTUAL COSTSDIRECT COSTS FORMTEXT ?????FACILITIES AND ADMINISTRATIVE COSTSN/A502920017526000TOTAL DIRECT COSTS FOR INITIAL BUDGET PERIOD (Item 10, Face Page)$ FORMTEXT ?????Program Director/Principal Investigator (Last, First, Middle):BUDGET JUSTIFICATION FORMTEXT ?????BIOGRAPHICAL SKETCHProvide the following information for the Senior/key personnel and other significant contributors. Follow this format for each person. DO NOT EXCEED FIVE PAGES.NAME:eRA COMMONS USER NAME (credential, e.g., agency login):POSITION TITLE:EDUCATION/TRAINING (Begin with baccalaureate or other initial professional education, such as nursing, include postdoctoral training and residency training if applicable. Add/delete rows as necessary.)INSTITUTION AND LOCATIONDEGREE(if applicable)YEAR(s)FIELD OF STUDYNOTE: The Biographical Sketch may not exceed five pages. Follow the formats and instructions below. A.Personal StatementBriefly describe why you are well-suited for your role in the project described in this application. The relevant factors may include aspects of your training; your previous experimental work on this specific topic or related topics; your technical expertise; your collaborators or scientific environment; and your past performance in this or related fields (you may mention specific contributions to science that are not included in Section C). Also, you may identify up to four peer reviewed publications that specifically highlight your experience and qualifications for this project. If you wish to explain impediments to your past productivity, you may include a description of factors such as family care responsibilities, illness, disability, and active duty military service. B.Positions and HonorsList in chronological order previous positions, concluding with the present position. List any honors. Include present membership on any Federal Government public advisory committee.C.Contribution to ScienceBriefly describe up to five of your most significant contributions to science. For each contribution, indicate the historical background that frames the scientific problem; the central finding(s); the influence of the finding(s) on the progress of science or the application of those finding(s) to health or technology; and your specific role in the described work. For each of these contributions, reference up to four peer-reviewed publications or other non-publication research products (can include audio or video products; patents; data and research materials; databases; educational aids or curricula; instruments or equipment; models; protocols; and software or netware) that are relevant to the described contribution. The description of each contribution should be no longer than one half page including figures and citations. Also provide a URL to a full list of your published work as found in a publicly available digital database such as SciENcv or My Bibliography, which are maintained by the US National Library of Medicine.D.Research SupportList both selected ongoing and completed research projects for the past three years (Federal or non-Federally-supported). Begin with the projects that are most relevant to the research proposed in the application. Briefly indicate the overall goals of the projects and responsibilities of the key person identified on the Biographical Sketch. Do not include number of person months or direct costs.Principal Investigator/Program Director (Last, first, middle): FORMTEXT ?????OTHER SUPPORTProvide active support for all key personnel. Other Support includes all financial resources, whether Federal, non-Federal, commercial or institutional, available in direct support of an individual's research endeavors, including but not limited to research grants, cooperative agreements, contracts, and/or institutional awards. Training awards, prizes, or gifts do not need to be included.There is no "form page" for other support. Information on other support should be provided in the format shown below, using continuation pages as necessary. Include the principal investigator's name at the top and number consecutively with the rest of the application. The sample below is intended to provide guidance regarding the type and extent of information requested. Refer to the specific instructions in Section I. For information pertaining to the use of and policy for other support, see “Policy and Additional Guidance.”FormatNAME OF INDIVIDUALACTIVE/PENDING Project Number (Principal Investigator) SourceTitle of Project (or Subproject)The major goals of this project are…Dates of Approved/Proposed ProjectAnnual Direct CostsPercent EffortOVERLAP (summarized for each individual)ACTIVE FORMTEXT ?????PENDING FORMTEXT ?????OVERLAP FORMTEXT ?????Diversity Questionnaire (Required by NIH)What is your sex/gender? FORMCHECKBOX Female FORMCHECKBOX MaleWhat is your ethnic background?Hispanic or Latino? FORMCHECKBOX Yes FORMCHECKBOX NoNot Hispanic or Latino? FORMCHECKBOX Yes FORMCHECKBOX NoUnknown or Not Reported FORMCHECKBOX Yes FORMCHECKBOX NoWhat is your racial background? FORMCHECKBOX American Indian or Alaska Native FORMCHECKBOX Native Hawaiian or other Pacific Islander FORMCHECKBOX Asian FORMCHECKBOX Black or African American FORMCHECKBOX White (non-Hispanic) FORMCHECKBOX More Than One Race FORMCHECKBOX Unknown or Not ReportedDo you have a disability? FORMCHECKBOX Yes FORMCHECKBOX No FORMCHECKBOX Do Not Wish to ProvideAre you from a disadvantaged background? FORMCHECKBOX Yes FORMCHECKBOX No FORMCHECKBOX Do Not Wish to ProvideIndividuals from disadvantaged backgrounds are defined as:1. Individuals who come from a family with an annual income below established low-income thresholds.? These thresholds are based on family size, published by the U.S. Bureau of the Census; adjusted annually for changes in the Consumer Price Index; and adjusted by the Secretary for use in all health professions programs.? The Secretary periodically publishes these income levels at . ?For individuals from low-income backgrounds, the institution must be able to demonstrate that such candidates (a) have qualified for Federal disadvantaged assistance; or (b) have received any of the following student loans: Health Professional Student Loans (HPSL), Loans for Disadvantaged Student Program; or (c) have received scholarships from the U.S. Department of Health and Human Services under the Scholarship for Individuals with Exceptional Financial Need.2. Individuals who come from a social, cultural, or educational environment such as that found in certain rural or inner-city environments that have demonstrably and recently directly inhibited the individual from obtaining the knowledge, skills, and abilities necessary to develop and participate in a research career.? Recruitment and retention plans related to a disadvantaged background are most applicable to high school and perhaps undergraduate candidates, but would be more difficult to justify for individuals beyond that level of achievement. Program Director/Principal Investigator (Last, First, Middle):CHECKLISTTYPE OF APPLICATION (Check all that apply.) FORMCHECKBOX NEW application. (This application is being submitted for the first time.) FORMCHECKBOX RENEWAL of grant number:Applicants must fulfill the following criteria: FORMCHECKBOX I am a U.S. citizen OR a non-citizen national OR can provide proof of lawful admission for permanent resident. FORMCHECKBOX I am NOT on a temporary or student visa. FORMCHECKBOX I have completed my MD or PhD. FORMCHECKBOX I have a guaranteed faculty appointment (not contingent on receipt of the PS2 award) FORMCHECKBOX I have not been the Principal Investigator of an NIH grant or contract (including R01, P, and K awards; previous R03 or R21 awards are permissible). FORMCHECKBOX I am willing and able to spend a minimum of 75% of my full-time professional effort on research and research career development activities. FORMCHECKBOX I intend to seek independent grant support during the award period. FORMCHECKBOX I have the full support of my supervisor and division director for this program (letter of support required with full application). FORMCHECKBOX I do not have another career development award pending (e.g. K08, K01, K23). FORMCHECKBOX I am not a CCHMC Procter Scholar or Trustee Grant awardee.APPLICANT CERTIFICATION AND ACCEPTANCE: I certify that the statements herein are true, complete and accurate to the best of my knowledge, and 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.SIGNATURE OF APPLICANT.(In ink. “Per” signature not acceptable.)DATE FORMTEXT ????? ................
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