01. Project Title 02. Response for Request Application 02a. Type of Application New Revision Continuation Supplemental 02b. If Yes, title of RFA 03.
Principal Investigator / Project Director
03a. Name (last, first, M.I.) 03b. Position/Title 03c. Department/Service/Lab or equivalent 03d. Telephone 03d. Fax 03e. E-mail Address 03f. Postal Address 04.
Proposed Period of Support
04a. From 04b. Through 05. Total Costs Requested 06. 1-st year Costs Requested 07.
If award is to be made by check
07a. Entity to which check is to be written 07b. Telephone of contact 07b. E-mail of Contact 07c. Postal Address which check is to be mailed 08.
If award is to be made by wire transfer, account and transfer information
08a. Account 08b. Transfer Information 09. Type Research Basic Translational Clinic 10. Human Subject Needed 11. Animal Subject Needed 12. List approval obtained 13. Name and Contact Information of Submitting Official 14. Date Submitted 15.
Project Description
15a. Desease Summary - Briefly describe FRDA, emphasizing the particular aspects this project is intended to address 15b. Project Objectives - Define broad, long-term objecttives, explaining how they would contribute to our mission 15c. Specific Aims - List and describe each specific aim, emphasizing its contribution to accomplishing the project objectives 15d. Research Design, Methods, Technologies and Techniques - Explain how the applicant intends to achieve each specific aim in 15c above. If a clinical study, explain power calculations and other bases for proposed patient enrollment and performance site selection 16. Key Personnel - Beginning with the Principal Investigator, list all key personnel by name & project role : 17. Collaboration - Explain applicant`s plan for collaboration on the project beyond the project`s Key Personnel. If cell cultures, as says, animal models, etc., are to be developed as a result of the project, explain applicant`s plan for promptly sharing such results throughout the community, as required of WF grantees. If applicant anticipates that costs will be associated with such collaboration, please itemize those costs as part of the detailed budget proposed in section 18. 18a. Personnel Costs 18b. Cost of Supplies (itemize) 18c. Equipment Costs (itemize) 18d. Patient Expenses 18e. Animal Costs 18f. Other Costs 18g. Financial support being received for this project from other sources 18h. Total cost requested from WF 19. Background Information on Principal Investigator and other Key Personnel 19a. Publication of key Personnel 19b. Reference Literature
