KL2/BIRCWH/PRES SEED Application

Georgia CTSA KL2 / Emory K12 BIRCWH / Emory PREHS SEED
Please fill in details below. Please check KL2 application web page for instructions.
Applicant First Name*
Applicant Last Name*
Applicant Email Address*
Your Georgia CTSA institution

Emory UniversityGeorgia Institute of TechnologyMorehouse School of MedicineUniversity of Georgia
For which program are you applying?

KL2-Georgia CTSAK12-BIRCWH (Emory faculty only)Both
For which program are you applying?

KL2 Georgia CTSAK12 BIRCWHK12 PREHS SEED
UGA applicants must notify the Assistant Director of the Owens Institute for Behavioral Research (OIBR), Kim Cherewick, of their intention to submit a KL2 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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Candidate + Research 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 KL2 / Emory K12 BIRCWH / Emory PREHS SEED