FLEXIBLE MINI SABBATICAL/LEAVE AWARDS
INSTRUCTION FORM
Resource Allocation Program (RAP)
University of California San Francisco

Proposal Length: maximum 6 pages, including figures and tables, excluding literature cited.
Format Requirements:  Arial font; 11 pt; minimum 0.5 inch for all margins; no appendices.

Please create one single PDF file including all of the following information:

1. Project Title
2. Amount Requested: $
3. P.I. Name
• Title
• Department/Affiliation
• Email address
• Box No. (or address)
• Phone
4. Abstract (one paragraph only, max 300 words)
5. Co-Investigator Names
• Titles
• Department/Affiliation
• Email address
• Box No. (or address)
• Phone
6. Grant Administrator:
• Title
• Mailing Address:
• Email
• Box No. (or address)
• Phone
7. Human Subjects.  Indicate if Human Subjects will be used or not. Supply the following:
• CHR date of approval
• CHR approval number
• Specify if pending
8. Animal Subjects.  Indicate if Animal Subjects will be used or not. Supply the following:
   • CAR date of approval
   • CAR approval number
   • Specify if pending
9. Human Stem Cells.  Indicate if Human Stem Cell will be used or not. Supply the following:
• CHR date of approval
• CHR approval number
• Specify if pending
10. Specify if you have been funded in the past 5 years by one of the following UCSF agencies:
    List titles of above grants in detail. Include enough information to allow RAP to understand their content. Specify dollar amounts awarded and source of funds (e.g., REAC).
• CTSI-SOS
• REAC
• CFAR
• ARI
• Cancer Center-CIRP
• NCOE
• Academic Senate
• Departmental Startup Funds
• Other UCSF (explain _____)
11. Proposal (maximum 6 pages, including figures and tables, excluding literature cited)
1. Aims
2. Background and Significance
3. Preliminary studies
4. Experimental Design and Methods (include time-table)
5. Explain how this pilot project is important for your career goals (e.g., lead to major funding, etc.)
6. Literature cited (not included in page limit)
12. Budget ($40,000 maximum per proposal) Use NIH Budget Page Form (one year)
    

	Allowable	Not Allowable
PI Salary	X
Post Doc Salary
Administrative Support
Supplies
Equipment
Software
Personal Computers *
Mailing
Tuition
Travel
Research Staff Support (e.g. RSA; Lab. Technician)
Patient Care
Indirect Costs		X

Administrative support, mail, travel, and personal computer purchase must be required specifically by the research project proposed, and must be clearly justified.

13. Budget Justification clearly justify all costs fully.
14. NIH BioSketch of Principal Investigator(s), Co-Principal Investigator(s) and Co-Investigator(s) (4 page format)
    Use Form "PHS 398/2590" from the NIH Grant Applications with other support pages. Include active, pending, and planned proposals. Include percent effort, total direct costs (current year) and potential overlap with the current proposal.
15. Letter of support
    For Assistant/Associate Professors requesting a Flexible Sabbatical Leave - please include a 1 page letter from your Department Chair, or other Head of Unit, describing the applicant independence, lab space availability, and stating that s/he supports the proposal and sabbatical leave request with appropriate signature , and that if an award is made, that s/he will relieve the applicant of teaching, patient care and other non-research responsibilities during the leave period, and not overburden the recipient after the leave is over.