2017 Washington University ACS-IRG Cover Sheet

Title of Project (no more than 81 characters):

Principal Investigator (PI) Name: (Last, First, Middle) Degree(s):

Title:

Applicant Organization:

Department: Division: E-mail Address: Phone Number:

Mentor (required): Division: E-mail Address: Phone Number:

Grant Administrator Grant Administrator Grant Administrator E-mail Address: Contact Name: Phone Number:

Indicate institutional approvals that are required for this project Live Animals Human Subjects Human Embryonic Stem Cells Radioactive Materials Recombinant DNA Indicate percentage of space to be used for this project between “lab/bench” and “clinical/other” % lab/bench % clinical/other Area of research and major techniques or methods for purpose of assigning reviewers

List Collaborators Name Department/Division Role

Lay Audience Summary (Maximum 150 words)