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

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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 email: redcap@mail.med.upenn.edu.

CCEB Senior Scholar
Last Name

CCEB Senior Scholar
First Name

CCEB Senior Scholar
Email

Submitting Unit:

Biostatistics Epidemiology

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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

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

Name:

Phone Number:

Email:

Sponsor URL:

Is this a subcontract from another institution?

Yes No

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Title:

* must provide value

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

* must provide value

Are you responding to an FOA?

Yes No

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If yes, supply the number:

Grant Type:

new resubmission non-competing renewal

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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

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If other, please specify:

Any subcontracts to other institutions on the project?

Yes No

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

Brief Project Description (one to two sentences):

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Do you want to upload the non-budgeted information?

Yes

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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

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If yes, have you contacted a biostatistics faculty member?

Yes

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Name of biostatistics faculty member already contacted:

MS Biostatisticians (BAC):

* must provide value

Yes No

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Data Management and/or Computing Personnel (CRCU):

* must provide value

Yes No

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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.