Georgia CTSA K12/BIRCWH Application

Georgia CTSA K12/Emory K12 BIRCWH
Please fill in details below. Please check Georgia CTSA K12 Scholars Program webpage for instructions.
Applicant First Name
Applicant Last Name
Applicant Email Address
Your Georgia CTSA institution
For which program are you applying?
For which program are you applying?
UGA applicants must notify the Assistant Director of the Owens Institute for Behavioral Research (OIBR), Kim Cherewick, of their intention to submit a K12 application. The Owens Institute will provide extensive pre-award proposal support in addition to important communication (to candidate and their department) about internal procedures related to Georgia CTSA.
Contact info: Kimberly Silvis Cherewick, ksilvis@uga.edu, 706-542-6078.
Cover Page

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Cover Letter from Applicant

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Abstract (30 lines max.)

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Introduction (if applicable, for first resubmission only; 1 page max.)

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Specific Aims (1 page max.)

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Research and Training Plan (12 pages max.)

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Facilities and Other Resources, Equipment

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Human Subjects/Data Safety and Monitoring Plan

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Literature Citations

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Budget

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Applicant NIH Biosketch

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Lead Mentor NIH Biosketch

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Co-Lead Mentor NIH Biosketch (if applicable)

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Co-mentor / Consultant / Advisory Committee Member 1 NIH Biosketch (if applicable)

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Co-mentor / Consultant / Advisory Committee Member 2 NIH Biosketch (if applicable)

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Co-mentor / Consultant / Advisory Committee Member 3 NIH Biosketch (if applicable)

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Co-mentor / Consultant / Advisory Committee Member 4 NIH Biosketch (if applicable)

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Co-mentor / Consultant / Advisory Committee Member 5 NIH Biosketch (if applicable)

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Department Chair Letter of Support

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Lead Mentor Letter of Support

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Co-Lead Mentor Letter of Support

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Co-mentor / Consultant / Advisory Committee Member 1 Letter of Support

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Co-mentor / Consultant / Advisory Committee Member 2 Letter of Support

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Co-mentor / Consultant / Advisory Committee Member 3 Letter of Support

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Co-mentor / Consultant / Advisory Committee Member 4 Letter of Support

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Co-mentor / Consultant / Advisory Committee Member 5 Letter of Support

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Additional Information
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Georgia CTSA K12/Emory K12 BIRCWH