Proposal setup form

PROPOSAL SETUP QUESTIONNAIRE

PI Name*

First Name

Last Name

PI email*

Sponsor*

Program*

Do you have a link to the solicitation or a solicitation document?*

Link Document Neither

Solicitation link*

Solicitation document*

No File Chosen

File uploads may not work on some mobile devices.

Proposal title*

Do you have any co-PIs at CU Denver or CU Anschutz?*

yes no

co-PI names and email addresses*

Are we a subrecipient to another institution?*

yes no

Lead institution and administrative contact information*

Period of performance start*

From

Period of performance end*

To

Will there be any subrecipients?*

yes no

Name of subrecipient institution(s) and administrative contact(s) information*

Will there be any consultants?*

yes no

Consultant(s) contact information*

Will any work for this project be performed at Children's Hospital Colorado?*

yes no

PI office building and room number*

Human subjects?*

yes no

IRB number:*

(if not approved yet, put "pending")

Most recent approval date

(if not approved yet, leave blank)

Will work with human subjects be done at University of Colorado Hospital, Children's Hospital Colorado, or any other non-UCD facilities?*

yes no

If "no", explain why*

Is this project a clinical trial?*

yes no

Project sponsor is*

Foreign Government Private Company Other Educational Institution US Government Agency State, County, or Municipality Agency Nonprofit/Foundation

Is there a CRO?*

yes no

Is this an investigator initiated study?*

yes no

Is this a multi-site clinical trial?*

yes no

Animal use?*

yes no

Protocol number*

(if not approved yet, put "pending")

Most recent approval date

(if not approved yet, leave blank)

Animal type(s)*

Radiation Use?*

yes no

Authorization number(s)*

(if not approved yet, put "pending")

Most recent approval date

(if not approved yet, leave blank)

Radioactive materials*

S35 P32 H3 C14 I125 Ionizing radiation generating equipment

Other:

Biohazards?*

yes no

Authorization number*

(if not approved yet, put "pending")

Date/Time

(if not approved yet, leave blank)

Biohazard type*

Recombinant DNA Infectious agents Select agents

Other:

Chemical hazards?*

yes no

Chemical hazards

DHS Chemicals of Interest (Apendix A) Toxic gases/vapors Explosives Peroxide formers DEA Controlled Substances Carcinogenic respirable particulates (asbestos, beryllium, etc) Perchloric acid

Other:

Dual use research of concern? http://www.phe.gov/s3/dualuse/Pages/default.aspx*

yes no

Does this proposal require the purchase of genomic arrays?*

yes no

Anything else you need me to know?