Program Director/Principal Investigator (Last, First, Middle): |
|
|||||||||||||
|
||||||||||||||
PROJECT SUMMARY (See instructions): |
||||||||||||||
|
||||||||||||||
RELEVANCE (See instructions): |
||||||||||||||
|
||||||||||||||
PROJECT/PERFORMANCE SITE(S) (if additional space is needed, use Project/Performance Site Format Page) |
||||||||||||||
Project/Performance Site Primary Location |
||||||||||||||
Organizational Name: |
|
|||||||||||||
DUNS: |
|
|||||||||||||
Street 1: |
|
Street 2: |
|
|||||||||||
City: |
|
County: |
|
State: |
|
|||||||||
Province: |
|
Country: |
|
Zip/Postal Code: |
|
|||||||||
Project/Performance Site Congressional Districts: |
|
|||||||||||||
|
||||||||||||||
Additional Project/Performance Site Location |
||||||||||||||
Organizational Name: |
|
|||||||||||||
DUNS: |
|
|||||||||||||
Street 1: |
|
Street 2: |
|
|||||||||||
City: |
|
County: |
|
State: |
|
|||||||||
Province: |
|
Country: |
|
Zip/Postal Code: |
|
|||||||||
Project/Performance Site Congressional Districts: |
|
PHS 398 (Rev. 09/07) Page 2 Form Page 2
Program Director/Principal Investigator (Last, First, Middle): |
|
||||||
|
|||||||
SENIOR/KEY PERSONNEL. See instructions. Use continuation pages as needed to provide the required information in the format shown below. Start with Program Director(s)/Principal Investigator(s). List all other senior/key personnel in alphabetical order, last name first. |
|||||||
Name |
eRA Commons User Name |
Organization |
Role on Project |
||||
|
|
|
|
||||
|
|
|
|
||||
|
|
|
|
||||
|
|
|
|
||||
|
|
|
|
||||
|
|
|
|
||||
|
|
|
|
||||
|
|
|
|
||||
|
|
|
|
||||
|
|
|
|
||||
|
|
|
|
||||
OTHER SIGNIFICANT CONTRIBUTORS |
|||||||
Name |
Organization |
Role on Project |
|||||
|
|
|
|||||
|
|
|
|||||
|
|
|
|||||
|
|
|
|||||
|
|
|
|||||
|
|
|
|||||
|
|
|
|||||
|
|
|
|||||
|
|
|
|||||
|
|
|
|||||
Human Embryonic Stem Cells |
No |
Yes |
|||||
If the proposed project involves human embryonic stem cells, list below the registration number of the specific cell line(s) from the following list: http://stemcells.nih.gov/registry/index.asp. Use continuation pages as needed. If a specific line cannot be referenced at this time, include a statement that one from the Registry will be used. |
|||||||
Cell Line |
|||||||
|
|||||||
|
|||||||
|
|||||||
|
|||||||
|
|||||||
|
|||||||
|
|||||||
|
PHS 398 (Rev. 09/07) Page 3 Form Page 2-continued
Number
the following
pages consecutively throughout
the
application. Do not use suffixes such as 4a, 4b.
File Type | application/msword |
File Title | PHS 398, fp2 (Rev. 9/07), Description, Performance Sites, Key Personnel, Other Significant Contributors, and Stem Cells, Form Pa |
Subject | DHHS, Public Health Service Grant Application |
Author | DHHS, Pubic Health Service |
Last Modified By | curriem |
File Modified | 2007-09-14 |
File Created | 2007-09-14 |