UNIVERSITY OF MINNESOTA

Complete this application by tabbing through and completing the fields below.

Applications are due March 15, 2007 by 4:30 p.m.

Submit the Proposal Routing Form signed by the principal investigator(s), the department head for academic faculty, and responsible official for the community organization to the Program in Health Disparities Research, G254 Mayo. 

1. Cover Page

1. Principal Investigator - University:       

Academic Dept:                     Rank:       

Principal Investigator - Community:                             

Organization:                                    Position:       

2. Corresponding Investigator:      
3. Contact information for Corresponding Investigator (mailing address, email address, phone, fax):       
4. Area(s) of health disparity addressed in the application (e.g., cancer, genetics, cardiovascular, etc.):                 
5. Proposed funding period:                 
6. Total funding requested: $                
7. Name(s) and organization(s) of project collaborator(s):      
8. Performance site of the research project:      
9. Use of human subjects or material, animal subjects or biohazardous materials requires approval of the appropriate University of Minnesota subject committee. Will human subjects, animal subjects or biohazardous materials be used? Y  N 

Approval date:                        Project number:         Pending*

*If pending, note that IRB approval will be required before award is made.

2. Project Title:           
   Provide a brief abstract of the project (up to 300 words).

3. Provide a non-technical summary of the project, emphasizing its anticipated significance (up to 150 words).
   
   

4. Provide an itemized budget (up to two pages; template provided).  List salaries, benefits, supplies, equipment, etc. Include justifications. 

5. For faculty P.I.: current NIH biosketch and Other Support (four-page limit).

6. For community-based P.I.: resume (four-page limit).

7. Provide a maximum 3-page, single-spaced research plan (font size not smaller than 12 pt), outlining specific aims, background, experimental plan/methods, significance, and implications of the research for future research initiatives/funding. References are not included in the 3-page limit. Appendices are not allowed.
   
   

Summary of Submission Instructions

Part I
Electronically submit application and all supporting materials as one .pdf file; total .pdf file not to exceed 20 pages, to PHDR@umn.edu. Call Kristin Eide, Executive Office Assistant, at 612-625-1654 with questions.

Part II
Submit original Proposal Routing Form and five copies of the grant application to Kristin Eide, Executive Office Assistant, Program in Health Disparities Research, Room G254 Mayo Memorial Building, MMC 451, 420 Delaware Street S.E., Minneapolis, MN 55455. Phone: 612-625-1654.