WACH FUND APPLICATION
WACH FUND APPLICATION
UNIVERSITY OF ILLINOIS AT CHICAGO – COLLEGE OF DENTISTRY
RESEARCH AWARDS COMMITTEE
|Project Title |
|Amount Requested |Beginning Date |Ending Date |
|New Faculty Yes No |Is a student involved in this research? Yes No |
|Location of Research Activities |
INVESTIGATORS
|Principal Investigator |Position Title |
|Department |Office |Extension |
|Co-Investigator (1) |Position Title |
|Department |Office |Extension |
|Co-Investigator (2) |Position Title |
|Department |Office |Extension |
|Co-Investigator (3) |Position Title |
|Department |Office |Extension |
Human subjects or tissues will be used. IRB Protocol Number: (attach approval letter)
Animal subjects will be used. ACC Protocol Number: (attach approval letter)
SIGNATURES
|Principal Investigator |Date |
|Co-Investigator (1) |Date |
|Co-Investigator (2) |Date |
|Co-Investigator (3) |Date |
|Department Head |Date |
|Department Head |Date |
RESEARCH AWARDS COMMITTEE USE ONLY
| Approved – Amount Funded | Deferred | Unapproved |
WACH FUND APPLICATION
UNIVERSITY OF ILLINOIS AT CHICAGO – COLLEGE OF DENTISTRY
RESEARCH AWARDS COMMITTEE
OTHER SUPPORT
For the investigators named on the cover sheet of this application, list in separate groups: (1) all currently active support; and (2) all applications and proposals pending review or funding. Continuation sheets may be used as necessary.
For each item give: (a) title; (b) source of support; (c) percentage of appointment on the project; (d) dates of entire project period; and (e) annual direct costs.
PRINCIPAL INVESTIGATOR
|(1) Current Support |
|(2) Pending Applications |
CO-INVESTIGATOR(S)
|(1) Current Support |
|(2) Pending Applications |
WACH FUND APPLICATION
UNIVERSITY OF ILLINOIS AT CHICAGO – COLLEGE OF DENTISTRY
RESEARCH AWARDS COMMITTEE
BIOGRAPHICAL SKETCH
|Name |Position Title |
EDUCATION: (Begin with Baccalaureate or other initial professional education and include postdoctoral training)
|INSTITUTION AND LOCATION |DEGREE |YEAR CONFERRED |FIELD OF STUDY |
| | | | |
RESEARCH AND PROFESSIONAL EXPERIENCE: Concluding with present position, list, in chronological order, previous employment and honors. List, in chronological order, the titles and complete references to all publications pertinent to this application. A continuation page may be used for page two. DO NOT EXCEED TWO PAGES.
WACH FUND APPLICATION
UNIVERSITY OF ILLINOIS AT CHICAGO – COLLEGE OF DENTISTRY
RESEARCH AWARDS COMMITTEE
PROPOSED BUDGET
|Personnel |% Time |Salary |Benefits |Total |
| | | | | |
| | | | | |
| | | | | |
| |Subtotal | |
|Equipment |Total |
| | |
| |Subtotal | |
|Supplies |Total |
| | |
| |Subtotal | |
|Computer Services |Total |
| | |
| |Subtotal | |
|Travel |Total |
| | |
| |Subtotal | |
|Other |Total |
| | |
| |Subtotal | |
Grand Total:
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