ICTR
ICTR AHEAD Pilot Program2021 Application Documents(Please contact Caitlin Scott with any questions, cscott8@wisc.edu)TITLE OF PROJECT Principal Investigator:NAME (Last, first, middle):DEGREE(S): POSITION TITLE & DEPARTMENT:CAMPUS MAILING ADDRESS: TELEPHONE: E-MAIL ADDRESS: eRA Commons Username: REQUESTED AMOUNT:HUMAN SUBJECTS: FORMCHECKBOX No FORMCHECKBOX Yes FORMCHECKBOX PendingIRB Approval Date: SPECIAL CRITERIA (List all that apply and indicate specific criterion, e.g., Marshfield collaboration.)Targeted research collaboration, Interdisciplinary collaboration, junior-senior partnership, Marshfield collaboration: ICTR AHEAD Pilot ProgramABSTRACT FormAbstract (maximum 500 words): Provide a concise description of the proposed research. The abstract must include descriptions of (1) the rationale supporting the proposed research; (2) the specific hypothesis or hypotheses to be tested and the expected results; (3) the research aims and design; and (4) how the project uniquely advances our understanding of the topic being addressed.Project/Performance Site: Primary LocationOrganizational Name: Street: City: State: Zip: Senior/Key PERSONNELNameeRA Commons NameOrganizationRole on ProjectOther Significant CONTRIBUTORSNameOrganizationRole on ProjectDETAILED BUDGET FOR 12-MONTH UW ICTR AHEAD PILOT PROJECT —DIRECT COSTS ONLYFromThroughKey Personnel Dollar Amount RequestedNAMERole on ProjectCalendar monthsAcademic monthsSummer monthsINST. BASE SALARYSALARYFRINGETOTALPI 7810509397900SUBTOTALS $Collaborator CostsConsultant or Contractual Costs Supplies (itemized by category)Participant CostsTravel (only for travel necessary to conduct of research)Other ExpensesTOTAL DIRECT COSTS FOR 12-MONTH PROJECT BUDGET$ ................
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