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  • Principal Investigator

  • Funding Agency

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  • Project

  • YYYY dash MM dash DD
  • YYYY dash MM dash DD
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    • Subcontractor

    • Please list one subcontractor per line.
    • Before responding below, for DHHS please check the Letter of Intent AND the Federal Demonstration Partnership (FDP) website to verify that the proposed subcontractor has a compliant conflict of interest policy. For NSF, please check the Letter of Intent to verify that the proposed subcontractor has a conflict of interest policy that complies with Department of Health and Human Services (DHHS) or National Science Foundation (NSF) standards, as applicable to this subaward.
    • Human Subjects

    • Animal Subjects

    • (NOTE: This includes any animal work conducted at UNC-CH, other domestic institutions, and/or foreign institutions. Please take into account any animal work performed at collaborating sites, fee-for-service arrangements, and/or subcontracts.) If NO, proceed to Research Material section below.
    • If YES, complete Sections 3-8 below. If NO, skip to Section 7 below.
    • If YES, complete Sections 4 and 5 below. If NO, skip to Section 6 below.
    • If YES, complete Sections 8-15 below. If NO, skip to Research Materials section below.
    • Check all that apply. Subcontract = Any external organization that performs grant-supported research activities involving animal subjects under a contract arrangement; Fee-for-service = Any entity conducting animal work for reimbursement; Collaborating Site = Any site conducting animal work that will not be under a subcontract or fee-for-service, i.e. no funds are requested
    • Check all that apply.
    • For animal work to be performed at institutions other than UNC-CH, for each institution please attach evidence of the institution's IACUC approval
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      • For animal work to be performed at institutions other than UNC-CH, for each institution please attach its most recent AAALAC accreditation letter.
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        • For animal work to be performed at institutions other than UNC-CH, for each institution please attach evidence of PHS Assurance.
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          • Research Materials

          • Radiation Safety

          • Chemical Safety

          • Biological Safety

          • Sub-Award

          • Export Control

          • Balkans, Burma, Cuba, Iran, Iraq, Ivory Coast, Lebanon, Liberia, Libya, North Korea, Rep. of Congo, Somaliam Sudan, Syria, Yemen and Zimbabwe
          • Intellectual Property

          • If Yes, Please Answer Questions A, B And C Below:
          • Community Engagement

          • Community Engagement describes the collaboration between institutions of higher education and their larger communities (local, regional/state, national, global) for the mutually beneficial exchange of knowledge and resources in a context of partnership and reciprocity. The purpose of community engagement is the partnership of college and university knowledge and resources with those of the public and private sectors to enrich scholarship, research, and creative activity; enhance curriculum, teaching and learning; prepare educated, engaged citizens; strengthen democratic values and civic responsibility; address critical societal issues; and contribute to the public good. (Carnegie Foundation for the Advancement of Teaching)

          • Please Distribute The Percentage Of Community Engaged Activity By Location. Total Must Equal 100%

          • Please Distribute The Percentage Of Community Engaged Budget By Location. Total Must Equal 100%

          • Locations of Budget Expenditures

          • Please indicate the locations where your research will occur and assign a percentage to each location. Percentages should reflect the portion of the total budget which would expended in that location.

            UNC-CH Locations: If any sponsored activities occur on campus, please enter below each on-campus location and the percentage of work that will be done there:

          • In-State County Locations: If any sponsored activities occur in-state, please enter below each in-state county location and the percentage of work that will be done there:

            Note: If activities occur on campus, do not also add Orange County as a separate In-State location.

          • Out-of-State Locations: If any sponsored activities occur in other U.S. States outside North Carolina, please enter below each state and the percentage of work that will be done there:

          • International Locations: If any sponsored activities occur outside of the Unites States, please enter below each location and the percentage of work that will be done there:

          • Locations Relevant to Your Project

          • Many projects are associated with a particular geographic location. For example, for projects involving or affecting human or animal populations (collecting new data or analyzing existing data), these geographic locations would be where the humans or animals live. For environmental studies, these geographic locations would include the site(s) of the phenomenon under study. Please add geographic location(s) relevant to your project below. Ensuring that all pertinent locations are reflected allows UNC-CH to accurately map the areas relevant to this project.
          • If the locations relevant to your project are in-state, please select each in-state county location below. Use CTRL+click to select multiple counties.
          • If the locations relevant to your project are in U.S. state(s) other than (or in addition to) North Carolina, please select each state below. Use CTRL+click to select multiple states.
          • If the locations relevant to your project are outside of the U. S., please select each relevant country below. Use CTRL+click to select multiple countries.
          • Additional Notes

          • Please use the space below for additional notes regarding your submission (Ex: Title is not finalized, Submission is tentative, Please verify dates are correct, Please verify that the opportunity is the current one for R01, etc.).