The code block below illustrates how one might use # and // as comments in your logic and calculations.

This value you provided is not a number. Please try again.

This value you provided is not an integer. Please try again.

The value entered is not a valid Vanderbilt Medical Record Number (i.e. 4- to 9-digit number, excluding leading zeros). Please try again.

The value you provided must be within the suggested range

The value you provided is outside the suggested range

This value is admissible, but you may wish to double check it.

The value entered must be a time value in the following format HH:MM within the range 00:00-23:59 (e.g., 04:32 or 23:19).

This field must be a 5 or 9 digit U.S. ZIP Code (like 94043). Please re-enter it now.

This field must be a 10 digit U.S. phone number (like 415 555 1212). Please re-enter it now.

This field must be a valid email address (like joe@user.com). Please re-enter it now.

The value you provided could not be validated because it does not follow the expected format. Please try again.

Required format:

mVZSHrxBVxTjEziR4HWJuigM6aZXg7bgZ6

CCEB Grant Registration Form

Returning?

A A A

Please complete this form and click on the "Submit" button below. Someone will contact you regarding your submission within two business days.

Please read this document before submitting a request.

NOTE: For Red Cap access, please contact Kathy Lasher. For survey access, please contact Scott Alberts.

CCEB Senior Scholar
Last Name

CCEB Senior Scholar
First Name

CCEB Senior Scholar
Email

Submitting Unit:

Biostatistics Epidemiology

reset

Date application to be submitted:

M-D-Y

Anticipated date of funding:

M-D-Y

Anticipated start date of project:

M-D-Y

Anticipated start date of data collection:

M-D-Y

Will data be collected at, or transmitted from, sites outside the University of Pennsylvania Health System and/or Delaware Valley Case Control Network?

Yes No Not Sure

reset

Sponsor (e.g., NIH, AHA, etc.):

Name:

Phone Number:

Email:

Sponsor URL:

Is this a subcontract from another institution?

Yes No

reset

Title:

* must provide value

Funding Mechanism:
(e.g., R01, P01, SCOR, Industry)

* must provide value

Are you responding to an FOA?

Yes No

reset

If yes, supply the number:

Grant Type:

new resubmission non-competing renewal

reset

Length of Project:
(# of years)

Total Costs (if budget cap):
(Year 01)

Total Costs (if budget cap):
(All years)

Indirect Cost Rate:

Federal Overhead Rate Clinical Trial Overhead Rate Other Overhead Rate

reset

If other, please specify:

Any subcontracts to other institutions on the project?

Yes No

reset

Please provide name of the institution, subcontract PI, and contact person:

Brief Project Description (one to two sentences):

Expand

Do you want to upload the non-budgeted information?

Yes

reset

Please upload your file.

Upload file

Last Name:

* must provide value

First Name:

* must provide value

Department:

Division:

Other than the PI, who is approved to see the budget information, including salaries?

Biostatistics Faculty Consultation Required?

Yes

reset

If yes, have you contacted a biostatistics faculty member?

Yes

reset

Name of biostatistics faculty member already contacted:

MS Biostatisticians (BAC):

* must provide value

Yes No

reset

Data Management and/or Computing Personnel (CRCU):

* must provide value

Yes No

reset

Project type (please check all that apply):

Survey

Case-control

Prospective cohort

Retrospective cohort

Randomized Clinical Trial

Other

If other, please specify:

NOTE: BEFORE submitting this form, save a copy for your files.

You have selected an option that triggers this survey to end right now.

To save your responses and end the survey, click the 'End Survey' button below. If you have selected the wrong option by accident and/or wish to return to the survey, click the 'Return and Edit Response' button.