Pilot 1Research Grant Application College of Allied Health Professions, College of Medicine University of Nebraska Medical Center

Title of Proposal:

Name of Principal Investigator: Department/Zip: Phone#

Name of Co-Investigator(s):

IRB Status (if applicable) Pharmacy & Therapeutics ___ Pending ___ Approved ___ N/A IRB # ___ Pending ___ Approved ___ N/A (Please attach documentation of approval letter)

Other Peer Review (e.g., Cancer Center Scientific Review Committee) Other Funding Source ___ Pending ___ Approved ___ N/A ___ Pending ___ Approved ___ N/A (Please attach documentation of approval letter)

Lay Summary of Project: Please provide a brief summary (a few paragraphs) of your proposed research project in language suitable for a news release to the lay public. The space should not exceed half of the page length.

1 Revised 5/25/17 Current and Proposed Funding Sources:

☐NIH Funded ☐NIH Pending *If NIH funded, enclose copies of your NIH Budget Sheets in their entirety.

☐Industry-funded ☐ Pending Enclose copies of the research agreement and itemized budget as well as the FDA letter assigning an experimental drug (IND) or device number (IDE) if applicable.

☐ Clinical Research Center, Nebraska Medicine ☐ Pharmacy Research Center, Nebraska Medicine ☐ Other:

☐ There is no other funding source for this project.

Please give plans for potential extramural application as a result of this project.

As the principal investigator, I understand that I am responsible for this project in its entirety. I attest that the information provided is accurate and that (if applicable) the patient will be informed which tests will be submitted for insurance billing and which will not. I agree to continuously supervise the investigations and to provide the required reports. I will notify the Assistant Dean for Research Development in writing of any changes in the status of this project or significant changes in protocol. I will also inform the Assistant Dean of any funding as a result of this pilot research.

PI Signature: ______Date: ______

2 Revised 5/25/17 General Instructions for Pilot 2Research Funds

Program Guidelines: Pilot Research funds are designed to provide limited, short-term support of research in areas where preliminary data are scant or lacking. Proposals submitted to this program should represent unique, novel ideas with the potential to open significant new avenues of research and research funding.

Eligibility: Faculty in the College of Allied Health Professions at the University of Nebraska Medical Center are eligible for support under this program.

Deadlines and Review: Applications for Pilot Research funds may be submitted at any time. Applications are assigned for peer review in the order received and applicants will be notified of the funding decision by the CAHP Office of Research within two months from the date the application is received.

Award Amount and Timelines: The maximum award amount is $10,000.00. Applications for requests under $1,000.00 will be reviewed by the CAHP Office of Research to determine award status. The grant timeline is 12-18 months (longer timelines considered, with strong rationale).

Human Subjects: If human subjects are involved, final funding will be contingent on IRB approval.

Submission Requirements:

Submit one hard copy and an electronic copy of the following to the Associate Dean for Research, Laura Bilek, PhD, at Zip 4000 and [email protected]:  Pages one and two of this application  Letter of Approval or copy of the IRB application if pending (if applicable)  Research Plan (include timeline)  Budget and Budget Justification

RESEARCH PLAN: Briefly describe your project and its relation to health science issues with emphasis on why it is novel, and why it is an important step in future research funding endeavors. The page limit is four pages using a typeface no smaller than 12 point Times New Roman or 12 point Arial (required margins: Left – 1 inch; Right and Bottom – 0.5 inches).

Elements should include the following: a. The long-term goal and specific hypothesis for the project as well as its role in future projects. b. A brief background on the current state of information in the area and its relevance to health issues. c. The scheme or general protocol for the project including primary and secondary endpoints. d. The methods that will be used including the statistical evaluation (since this is pilot research, the statistical vigor may be less but you should provide your rationale for the sample size of the end points as a basis for future power analysis and studies). e. The timeline for the project. f. Literature citations.

3 Revised 5/25/17 BUDGET AND BUDGET JUSTIFICATION:

There is no space on the budget page for “Equipment” or “Travel.” Funds for these budget categories under Pilot Research are only provided in exceptional circumstances and the request for such funds must be discussed in advance. Pilot Research funding is not intended to be a faculty salary award. The term of Pilot Research funding is 12-18 months (longer timelines considered, with strong rationale).

Requested Budget

Budget Categories Personnel (list by name, give role in project) % effort Salary Fringe benefits Total

Total personnel $ Consumable supplies

Total supplies: $ Other expenses

Total other $ costs

Total DIRECT $ ______costs requested

Budget justification:

4 Revised 5/25/17