GRANT APPLICATION SUMMARY
UNSOM - OFFICE OF MEDICAL RESEARCH (OMR)

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(Complete and submit a hard copy with the Signature Pages from the Grant Application or OSPA Transmittal Form) Please fill in the information in all fields * all items in red are required
Principal Investigator
Name:		Phone:
Email:		Department:
Grant Information
Title:
Research Focus and keyword identifiers: (e.g. Heart Disease and ion channels, Cancer and metastasis, Rural Health and telecommunications, etc.) Use as many keywords as applicable as this information may be shared with non-scientists/clinicians
PI and % Effort:
Co-Investigator(s) and % Effort (e.g., John Smith - 60%) :
Identify Funding Agency:
Agency Category:		Federal State Public Private
Federal Grant Category		unknown RO1 R21 P20 CO6
New or Competing Continuing or Non-Competing
Assigned Grant Number/Identifier from Funding Agency (If known):
OSPA No. (Completed only after assignment):
Total Direct Cost:	$	F & A rate (%):
Submission Date:		Requested Term for Funding:
Start Date: