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/^((02([-\/])29\3(\d{2}([13579][26]|[2468][048]|04|08)|(1600|2[048]00)))|((((0[1-9]|1[012])([-\/])(0[1-9]|1\d|2[0-8]))|((0[13-9]|1[012])([-\/])(29|30))|((0[13578]|1[02])([-\/])31))(\11|\15|\19)\d{4}))$/

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ucjIiZMNIZKTsTweXUkTbsi9FSJGvomQNzBZwGqF7ZdsiCMa2nmRjqhAmrtzpz9YmSxWwmFjYZIExzBgID8DRZQ

COVID-19 Research Assistance Fund

Please complete the full application below for your COVID-19 Research Assistance Fund.

Questions can be directed to Lindsay Trost at ltrost@wakehealth.edu.

COVID-19 Research Assistance Fund RFA

Attachment:

COVID 19 Research Assistance Fund RFA FINAL.pdf

Where does this project fall on the Translational Science Spectrum?

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Which funding cycle are you applying to?

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Cycle 1: Deadline 2/1/21

Cycle 2: Deadline 5/2/21

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Project Title

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Principal Investigator Name

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Faculty Rank

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The information requested about the Principal Investigator is voluntary and will not affect the success of your pilot application. The data will only be used for reporting and not shared with any reviewer.

Race

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Gender

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Number of Project Key Personnel (do not include PI)

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Key Personnel 1 Name

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Key Personnel 1 Rank

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Key Personnel 2 Name

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Key Personnel 3 Name

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Key Personnel 4 Name

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Key Personnel 5 Name

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Key Personnel 5 Rank

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Key Personnel 6 Name

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Key Personnel 7 Name

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Key Personnel 8 Name

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Key Personnel 9 Name

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Rationale for Support (2 pages max)

Overview of Research Activity
- Significance
- Innovation
- Approach
- Study Team
Impact of COVID-19 on research
Anticipated future outcomes if funded

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References (no page limit)

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Does the proposed work involve human subjects?

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Yes

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Are the participants prospectively assigned to an intervention?

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Yes

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Is the study designed to evaluate the effect of the intervention on the participants?

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Yes

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Is the effect that will be evaluated a health-related biomedical or behavioral outcome?

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Yes

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IRB Approval

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IRB Number

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Type of Clinical Trial

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Addressing Human Subjects (1 page max)

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Inclusion Plans for Women, Minorities, and Children (if not applicable, upload a document stating this)

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Does the proposed work involve live vertebrates?

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IACUC Approval

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IACUC Number

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Finalized Budget Upload (using Pilot Budget Template)

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Budget Justification (1 page max)

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Biosketch for ______

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Biosketch for ______

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Biosketch for ______

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Biosketch for ______

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Biosketch for ______

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Biosketch for ______

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Biosketch for ______

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Letter(s) of Support, if needed

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Other Supporting Documentation, if needed

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