CCEB Grant Registration Form

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CCEB Senior Scholar:
Submitting Unit: Biostatistics Epidemiology

PROPOSAL INFORMATION

Title:
Funding Mechanism:
(e.g. R01, P01, SCOR, Industry)
Grant Type: New
Resubmission
Non-Competing Renewal
Length of Project: Years
Total Costs (if budget cap): Year 01 All Years
Indirect Cost Rate: Federal Overhead Rate
Clinical Trial Overhead Rate
Other Overhead Rate (specify):
Project Description (brief 1-2 sentences):

PRINCIPAL INVESTIGATOR INFORMATION
Name:
Department:
Division:

COLLABORATIVE PERSONNEL AND RESOURCE NEEDS

Biostatistics Faculty Consultation Required: Yes No
If yes, have you contacted a biostatistics faculty member? Yes No
If yes, name of biostatistics faculty already contacted:
MS Biostatisticians: Yes No
Data Management and/or Computing Personnel: Yes No

PROJECT INFORMATION
Project type (please check all that apply):

Survey
Case-control
Prospective cohort
Retrospective cohort
Randomized clinical trial
Other:

Date application to be submitted:
Anticipated date of funding:
Anticipated date of start of project:
Anticipated start of data collection:

Will data be collected at, or transmitted from, sites outside the University of Pennsylvania Health System and/or the Delaware Valley Case Control Network?

Yes No Not sure