CCEB Senior Scholar:
: Proposal Information
Date application to be submitted (mm/dd/yyyy):
Anticipated date of funding (mm/dd/yyyy):
Anticipated start date of project (mm/dd/yyyy):
Anticipated start date of data collection (mm/dd/yyyy):
Will data be collected at, or transmitted from, sites outside the University of Pennsylvania Health System and/or Delaware Valley Case Control Network?
Sponsor (e.g., NIH, AHA, etc.):
Sponsor Contact Information:
Is this a subcontract from another institution?
(e.g., R01, P01, SCOR, Industry)
Are you responding to an FOA?
If yes, supply the number:
Length of Project:
Total Costs (if budget cap):
Indirect Cost Rate:
Federal Overhead Rate
Clinical Trial Overhead Rate
Other Overhead Rate (specify):
Any subcontracts to other institutions on the project?
If yes, please provide name of the institution, subcontract PI, and contact person:
Brief Project Description (one to two sentences):
Do you want to upload the non-budgeted information?
: Principal Investigator Information Name:
Other than the PI, who is approved to see the budget information, including salaries?
Collaborative Personnel and Resource Needs
Biostatistics Faculty Consultation Required?
If yes, have you contacted a biostatistics faculty member?
If yes, name of biostatistics faculty member already contacted:
Data Management and/or Computing Personnel
Project type (please check all that apply):
Randomized Clinical Trial
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