Intent to Submit Form

Intent to Submit Form

Please provide as much of the requested information as possible. This information helps us determine internal deadlines, checklists and prepare draft budgets.

Once we receive your completed form, a pre-award team member will contact you to discuss proposal details.

YOUR INFORMATION

Your Name:*

Last Name, First Name

Your UMN email address:*

Select or enter value

Are you...*

Faculty

Trainee

Whose lab are you currently working in?*

PROPOSAL INFORMATION

Are you submitting a fellowship?*

Individual fellowship opportunities (e.g., F31, F32); Does not include Career Development Grants (K-awards)

Yes

No

Is it a NIH fellowship application?*

(i.e., F30, F31, F32)

Yes

No

Fellowship Type:*

New

Resubmission

Supplement

Proposal Type:*

New

Resubmission

Competitive Renewal

Supplement

Other

Other (please specify):*

Grant Number:*

Funding Sponsor/Agency:*

(e.g., NIH, University of Wisconsin (DOD Prime))

Is the UMN a subaward?*

Yes

No

Please list the primary project site:*

Request for Application (RFA) Number:*

If no RFA number is available please paste the URL linked to the funding announcement or attach a PDF version in the Upload section found below.

Proposal Due Date:*

Project Title/Working Title:*

If unknown, enter working title or "TBD."

Short Project Summary (i.e., Goals, Aims):*

Please provide a short summary/abstract of the project--including major goals--to be used internally when communicating with other departments, divisions and SPA. May be used by other depts as the grant descriptor on Other Support Pages.

Project Type:*

Research

Equipment only

Training Grant

Clinical Trial

Other

Research Type:*

Basic

Applied

Development

Basic %*

%

Applied %*

%

Development %*

%

Clinical trial is:*

Sponsor Initiated

PI Initiated

Other project type (please specify):*

Will this be a multiple PI lead proposal?*

Yes

No

Does this proposal include any outgoing subawards?*

Yes

No

Outgoing Subaward Information:*

Please provide institution name and contact person information.

Does this proposal include any planned activity with the community or other outside entities (excluding subawards)?*

Yes

No

What type of entity/entities will be involved (select all that apply)?*

Other higher educational institution(s)

Governmental agency

K-12 schools or other non-higher education agencies

Healthcare organization

For-profit business and/or industry

Non-profit and/or registered 501(c)3 organization

Community group (e.g., neighborhood association, informal citizens group)

Indigenous population/tribe or work on Indigenous-owned or managed lands

Other

Other entity (please describe):*

Describe the primary role(s) of the involved entity/entities:*

Does this proposal contains an international component (consultant, travel, etc)?*

Yes

No

Cell Phone Number:*

Required for NIH fellowship applications

If seeking a degree during this award, please indicate the degree and expected completion date:

Field of Training for Current Proposal:*

Please select from the NIH Field of Training list.

Have you received prior Kirschstein-NRSA Support?*

Yes

No

What is your current year of training?*

(e.g., Year 1 Graduate Student, Year 3 Postdoc, etc)

What is your citizenship status?*

U.S. Citizen or Non-Citizen National

Non-U.S. Citizen with a Permanent U.S. Resident Visa

Non-U.S. Citizen with a Temporary U.S. Visa

Are you submitting any other applications for concurrent support?*

Yes

No

REGULATORY COMPLIANCE

Does this project involve any of the following?

Human subjects*

Human subject means a living individual about whom a researcher obtains: 1) Data through intervention or interaction with the individual OR 2) Identifiable private information.

Yes

No

IRB Protocol Number:

Animal subjects*

Yes

No

IACUC Protocol Number:

Recombinant or synthetic nucleic acid molecules, infectious agents, or biologically-derived toxins*

Yes

No

IBC Protocol Number:

Purchase/use of custom antibodies produced in animals housed outside the University*

Yes

No

Human embryonic stem (hES) cells*

Yes

No

This research will involve:*

Human embryos

Human pluripotent stem cells that are intended to make or contribute to an embryo, germ cell (oocytes or sperm), or mixed human-animal entity

Specific stem cells cannot be referenced at this time, one from the registry will be used

Human fetal tissue or cell lines derived from human fetal tissue*

Yes

No

The fetal tissue or cell lines derived from human fetal tissue:

Will be used in non-transplantation research or teaching

Will be used for therapeutic purposes

Radioactive materials and/or ionizing or nonionizing radiation producing equipment*

Yes

No

Human blood, body fluids, or other potentially infectious materials*

Yes

No

Chemicals*

Yes

No

Export or import of tangible research material(s) to or from another country*

Yes

No

Please list the country(ies):*

University of Minnesota personnel conducting fieldwork in another country*

Yes

No

Please list the country(ies):*

FINANCIAL COMPLIANCE

Does a potential financial and/or business conflict of interest exist?*

Yes

No

Is it likely that anything patentable will result from the current research project?*

Yes

No

Have any inventions been conceived or reduced to practice under prior research on this project?*

Yes

No

Was the invention previously reported to Technology Commercialization?*

Yes

No

Does this proposal contain third party or University confidential information?*

Yes

No

BUDGET INFORMATION

How many years of funding are you requesting?*

Anticipated Project Start Date:

Key Personnel:*

Please list the name, role on project, and estimated effort for all key UMN personnel on this project.

This does not need to be a final list. This information will be used to create a draft budget. Please include your % effort too!

Other Personnel:

Please list the name, role on project and effort for all other paid personnel and/or unpaid collaborators on this project.

This does not need to be a final list. This information will be used to create a draft budget. Please also include ToBeNamed Positions (i.e. TBN Postdoc, TBN Grad Student, etc.).

ADDITIONAL INFORMATION

Additional Comments:

Provide any additional information/comments/notes here. Be sure to highlight unusual terms or conditions that you notice in the FOA.

Uploads:

Attach any relevant documents here (e.g., RFA).

Drag and drop files here or

Send me a copy of my responses

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