APPLICATION COVER PAGE Principal Investigator Information Name  

application cover page principal investigator information name:   phone:   email:   mailstop:  

APPLICATION COVER PAGE
Principal Investigator Information
Name:
 
Phone:
 
Email:
 
Mailstop:
 
Academic Rank:
 
Department/Division:
 
Explanation of situation and future plans
 
Funding History - Provide information for previous externally funded
grants (from the past five years), current and pending support that
includes all federal, private and internal sources, and recent
attempts to obtain funding (include abstracts of submitted grants,
panel reviews, pending clinical trial agreements, priority scores or
other evaluations and comments – you may submit these as separate
attachments with your application).
Include name of funding source, project title, amount of annual
budget, number of years, dates, and role (PI, Co-PI, etc.)
 
By signing and submitting this application, the applicant agrees that
they have read and understand the CCTR Bridge Funding Program
Overview.
Principal Investigator Signature:
Electronic signature is acceptable
 
Date: