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HIGUCHI BIOSCIENCES CENTER (HBC)
Proposal Information Sheet
Budget template sample
PHS PI Assurance Signature Page
Financial Conflict of Interest instructions
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Visit HBC website for more information www.hbc.ku.edu
Email [email protected] for proposal help
HBC Proposal Information Sheet
Please complete all questions and email the completed form to hbcgrant(5)ku.edu or d456b456(a)ku.edu.
Principal Investigator
Department:
Phone Number:
Fax Number
Email:
Pl Effort on Project
Title of Project:
Please use the following web site to choose key words:
Three keywords:
http://research.ku.edu/node/381
Will this proposal include any Co-lnvestigator(s) at KU?
Name
Yes
No
Email
Will this proposal include any Subcontracts?
Effort
Yes D
No
a
Yes
No
a
Name:
Institution:
Email:
Name:
Institution:
Email:
Is this proposal a resubmission of a previous proposal?
Granting Agency:
Due Date:
Name/Number or link to the announcement:
If NSF please list program number
Is this a submission to a PHS or PHS compliant Agency? Yes D No D Don't know
Is there any cost share/match planned in this budget?
Yes D No D
Is it required?
Yes D
No
D
Will there be any other KU personnel listed in the proposal?
Yes D
No
D
Name
Title/Role on project
% Effort
Will there be any travel?
Yes
No
Will there be any supplies?
Yes
No
Yes
No
a
Please check all that apply
D Animal Purchase
D Chemicals & Reagents
D Other (list):
D Kits & media
D Consumables
Will there be any other costs?
Please check all that apply
Tuition (for GRA's only)
D Animal Care
D Other (list);
Publications
D Lab/User Fees
Are you identifying Haskell Indian Nations Univ. in your proposal? Yes Q No Q
olic
If NSF proposal are you considered a beginning investigator?
Yes D
No
Will this proposal include any Letters of Support?
Yes
No
Yes
No
D
Name:
Institution:
Email:
Name:
Institution:
Email:
Name:
Institution:
Email:
Will this proposal include any paid Collaborators or Consultants?
Name:
Institution:
Email:
Are they considered key personnel
Yes
No
D
Name:
Institution:
Email:
Are they considered key personnel
Yes
a
No
Compliances: Please go to http://www.ras.ku.edu/checklist/index.shtml to complete
the Pl Checklist (compliance form). This is a mandatory process for all proposals even
if you have no compliances with this project. Please list HBC as the Project
Administrative Unit.
D
Common internal deadlines for all proposals:
Biosketch and resources: 1 week after HBC notification of working on proposal or 3
weeks before deadline date.
Budgets and budget justification: 2 weeks after HBC notification of working on proposal
or 2 weeks before deadline date.
Draft of research for internal review: 1 week prior to funding institution deadline
Letters of support: 1 week prior to funding institution deadline
Final research: 2 days prior to funding institution deadline
External Review Request
If requested the HBC Grant Services Staff will coordinate a blind review of proposals for
professors. Due to the lead time necessary to coordinate this program, HBC Grant Services
must be contacted two months prior to submission deadline. Proposal draft fscjentific
text) must be completed at least one month prior to the submission deadline.
Are you requesting an external review?
Please list 3-5 potential reviewers
Yes D
No
n
YEAR ONEYEAR TWO
YEAR THREE
YEAR FOUR
YEAR FIVE
Category
Personnel/Role
K
4% adj
Base Salary
effort
$
2% adj.
2% adj.
2% adj.
2% adj.
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
Total Personnel
0
0
0
0
0
Equipment
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
Principal Investigator
0
Fringe
$
Fringe
0
35.00%
$
Fringe
s
35.00%
$
Fringe
0
35.00%
$
Fringe
0
35.00%
35.00%
$
Fringe
7.00%
animal purchase
chemicals & reagents
kits & media
consumables
Modular Reserve
Supplies
0
Travel
Subaward Direct Costs
Subaward F & A
Total Subaward
Other
tuition
animal care
lab/user fees
publications & information dissemination
Total Direct Costs
0
0
0
0
0
Modified Total Direct Costs
0
0
0
0
0
F & A 50%
0
0
0
0
0
Total Project Costs
0
0
0
0
0
Total KU Direct Costs
Total KU F&A
0
0
0
0
0
0
less tuition, equipment, subawards >$25,000, fellowships
Total Subaward Direct Costs
Total Subaward F&A
Project Direct Costs
Total Project Costs
3/24/2014 2:48 PM
PHS PI ASSURANCE SIGNATURE PAGE
As a result of the NIH change in policy effective for PHS 398 applications
prepared for submission/receipt dates on or after May 10, 2006, the signature of the
Principal Investigator is no longer required as part of the submitted application.
However, organizations must retain a unique signature and date for each submitted
application and have this on file and available as part of the compliance
requirement. This assurance page will satisfy this requirement.
Dr. PI Name is submitting a proposal to NIH entitled "proposal title". This
assurance page includes the following certifications:
(1) that the information submitted within the application is true, complete and
accurate to the best of the Pl's knowledge;
(2) that any false, fictitious, or fraudulent statements or claims may subject the
PI to criminal, civil, or administrative penalties; and
(3) that the PI agrees to accept responsibility for the scientific conduct of the
project and to provide the required progress reports if a grant is awarded as a
result of the application.
PI Signature
Please sign and date this form. Thank you.
Date
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Journal Articles
1: jTj Sadikot T, Swink M, Eskew JD, Brown D, Zhao H, Kusuma BR, Rajewski RA, Blagg BS, Matts RL, Hoizbeiertein JM, Vtelhauer GADevelopment of a high-throughput screening cancer cell-based lucfferase refoldino assay forjdentffying HspSO inhibitors- Assay Drug Dev
Technol, 2013 Oct;11(8):478-88. doi: 10.1089/adt2012.49
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,3 Oct 15- PubMed PMID: 24127661
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