KL2/BIRCWH/PRES SEED Application

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)

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

Once letter of support is uploaded, it cannot be seen.

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

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

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

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

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

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

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

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

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

Additional Information

Check if this submission is final

Final

Georgia CTSA KL2 / Emory K12 BIRCWH / Emory PREHS SEED