Second-Year Funding Request

Transcription

1 Form 1. Cover page Updated 09/29/2017 Second-Year Funding Request Select one: Oncology Research Award Cardiac Research Award Date: Cardiovascular Surgery Research Award Principal investigator: (Include terminal degree) Project title: Department: Address: Street address City, State Zip Phone: ( ) Fax: ( ) Total amount requested: $ All grant-related correspondence will be addressed to the investigator at the address above.

2 Form 2. Summary of Work Completed (Limit to three pages) Summarize the work that has been completed during the past year of project funding. If project is delayed from original proposal, provide explanations for delays and address any challenges that have been overcome. 2

3 Form 3. Work Proposed in Second Year (Limit to three pages) Provide an overview of the work to be accomplished during the requested period. Include design and methodology for any new aim or objective proposed. 3

4 Form 4. Timeline and Dissemination Plan (Limit to one page) Provide a project timeline for the requested period. Also provide a plan for dissemination of results including the potential peer-reviewed journals for publication, presentations, and any data sharing repositories. 4

5 Form 5. References 5

6 Form 6. Financial Report Include a copy of the most current monthly expense report (provided by the post award grant specialist). If previously awarded funds will remain after current project period, explain how these will be used. 6

7 Form 7. Requested Budget Budget category Detailed budget for Year 2 Personnel Name Role % Effort Annualized base salary Salary requested Fringe benefits* Total Personnel subtotal Supplies (Itemize by category in budget justification) Equipment (Maximum of 30% of the budget) Patient care costs Travel Other expenses (itemize) Total direct costs Consortium/contractual costs: direct costs $ (Attach detailed budget; indirect costs not allowed) Total funding request *Fringe benefits at Aurora Health Care are calculated at 25.5% of the base salary (as of Feb. 2017). Other institutions will have different fringe benefit rates. Note: Salary support should only be requested for personnel who would not be able to perform the work proposed unless it is funded by the award. Personnel who are employed by Aurora Health Care to carry out the work as part of their normal job duties should not request salary support from the award. 7

8 Form 8. In-Kind Budget Budget category Detailed budget for Year 2 Personnel Name Role % Effort (in-kind) Annual base salary* Salary (in-kind) Fringe benefits* Total Personnel subtotal Supplies (Itemize by category in budget justification) Equipment (Maximum of 30% of the budget) Patient care costs Travel Other expenses (itemize) Total in-kind The purpose of the in-kind budget is to identify the full cost of the research proposal for Aurora Health Care and will not be shared outside of the Sponsored Programs Office and Aurora Intramural Research Awards Executive Committee. *Salary for in-kind budget is not required for proposal submission and will be calculated by the Sponsored Programs Office based on the % Effort provided. 8

9 Form 9. Budget Justification (Limit to three pages) A. Personnel name, role (X% effort, 12 months) Explain what this person is doing and why they re qualified to do it. Please include the principal investigator and all other personnel, regardless of whether they are receiving funding for this project. Examples: John Smith, MD, Principal investigator (10% effort, 12 months) $12,480 Dr. Smith will serve as principal investigator for this grant. He will oversee all aspects of the work and coordinate the research. He will work with administration to meet the goals stated in the proposal, as well as report on the findings. Dr. Smith will present the results of this study at national scientific conferences. Dr. Smith is Chief Neurosurgeon at Aurora Health Care and Director of the Neurosurgery Fellows Program. Through these roles, he is experienced at assessing neurosurgery techniques and working with the community to improve outcomes. Jane Doe, PhD, Co-investigator (5% effort, 12 months) cost share Dr. Doe will be a co-investigator and brings expertise in the field of neural stem cells. As Chief of Neural Stem Cell Studies at the Stem Cell University, she has researched neural stem cells and their clinical implications for 20 years. Dr. Doe will grow and treat neural stem cell cultures, perform RNA and protein analyses, and write/submit publications. B. Supplies Include small equipment purchases (under $5,000), as well as disposable supplies, such as computers, software, drugs, lab supplies, etc. List and describe general supply categories if over $1,000. If possible, briefly explain how costs were estimated. C. Equipment Typically any item that costs at least $5,000 and has a lifespan of at least one year. Specify the equipment type and give more details when possible, such as the vendor, model, and how price was determined. Explain why this equipment is critical for project success. D. Patient Care Costs Specify whether the costs are in-patient or out-patient, identify the hospitals/clinics used, and indicate whether these hospitals/clinics have a DHHS patient care rate agreement or how charges were determined. Show calculations including number of patients and costs per test/treatment. Please note that these costs do not include tests done in research/commercial laboratories, patient travel/lodging costs, or participant compensation, which are covered by Other Costs. E. Travel Explain why the travel is important to the project. Specify the destination/purpose (such as a conference), number of total trips, and number of people traveling. Explain how costs were calculated. F. Other Expenses If it doesn t fit elsewhere, then put it here. Other Expenses includes the cost of animals, maintenance, service fees (such as non-clinic tests), communications, printing, mileage, publications, consultants, location rentals, etc. List each type of expense, state its necessity, and explain how costs were determine. 9