SHARED INSTRUMENT 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. Description. A description of the instrument/technology, its need, and suitability for shared use. Include a clear description of other pieces of equipment on campus which are currently available, and why the purchase of new equipment is necessary at this time
2. Management. Administrative coordination of equipment usage should be described, including how costs for maintenance and supervision will be distributed. Location proposed for new equipment should be addressed
3. Research Areas. Include a brief (1 paragraph) description from each of the co-investigators describing how their research program will benefit from the requested equipment
4. Clinical and Translational Research. Please state whether your proposal should be considered Clinical/Translational Research and justify (1 paragraph)
5. Literature cited (not included in page limit)
12. Budget
    Include a budget for $60,000 (maximum) if you believe this is a novel technology which qualifies for CTSI funding. Include a separate budget for $30,000 (maximum) if you qualify for REAC funding (SOM faculty status). 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. Computers should be clearly justified as necessary to run specific equipment, not for office use.

13. Budget Justification
    Clearly state and justify each item in the budget, including why this model (rather than a more or less expensive model) of this equipment is necessary. A quote from the manufacturer is helpful for review.
    The cost for large pieces of equipment is expected to be shared among several sources, including departmental funds, individual research grants, and Academic Senate. Proposed distribution of expenses should be clearly stated.
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.