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).
• SOM Dean's Bridge Funding Award
• 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. Reason for Hardship. A clear explanation of how the funding lapse has come about and steps which the PI has taken to overcome this hardship (1 page maximum).
2. Abstract/ Summary page and Specific Aims of extramural applications which have not been funded.
3. Critiques of previously submitted grants which have not been funded. Include correspondence with extramural agencies if appropriate.
4. Progress report. Include 1-2 pages describing work done since the last extramural submission.
   Note: The 6 page limit refers to a+d; the application should also include b+c, but the pages don't count against the limit.
12. Budget ($30,000 maximum per proposal) Use NIH Budget Page Form (one year)
    

	Allowable	Not Allowable
PI Salary		X
Post Doc Salary	X
Administrative Support		X
Supplies	X
Equipment	X
Software	X
Personal Computers *		X
Mailing		X
Tuition		X
Travel		X
Research Staff Support (e.g. RSA; Lab. Technician)	X
Patient Care		X
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
    Explain the intended use of hardship funds. Clearly describe all funds which are available to you and your laboratory from both intramural and extramural sources (included in your Biosketch/Other Support). State whether you have applied for SOM Bridge Funding. State whether you have requested hardship funds from your department.
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. Departmental Approval
    Department Chair/Unit Head should indicate support for the application with signature.