Application Details
This application has 5 sections (Details, Investigators, Project, Review, Proposal)
SECTION 2
Primary Investigators
PI 1 (Contact PI) Information
The account user name must match the PI1 name. To submit on behalf of a PI, sign in using their credentials (their email and password).
Last Name
Middle Name
First Name
Email Address
To avoid spam & junk mail issues, use of web-based emails (Gmail, Yahoo) is discouraged. If possible, use a UCSF email address.
Phone###-###-####
Extension
Degrees
MD PhD MCR/MPH/MS DDS RN PharmD Other
If Other Degree
Series
Rank
School
Department
Gender
Male Female Other
Ethnicity
Race
Time Spent in Research
Time Spent in Clinic
Are you currently a K awardee?
Yes No
Have you received funding from a RAP Funding Agency in the past three years?
Yes No
Mentor (if applicable)
Last Name
First Name
Post Award Analyst
Last Name
First Name
Add a second primary investigator.
SECTION 3
Project Details
Abstract
One paragraph only, maximum 300 words
Budget Requested
$
Numbers only
Does your budget include a component for travel?
Yes No
Does your project involve payments to international organizations/research expenses in other countries?
Yes No
Does your project involve human subjects?
Yes, CHR/IRB Approval # is
Yes, CHR/IRB Approval Pending
Yes, CHR/IRB Approval Planned
No, CHR/IRB Not Applicable
Does your project involve human stem cell?
Yes No
Does your project involve animal subjects?
Yes, IACUC Approval # is
Yes, IACUC Approval Pending
Yes, IACUC Approval Planned
No, IACUC Not Applicable
Co-Investigators
Last, First Name
Add an additional Co-Investigator.
Does this project involve an invention that has the potential for patenting?
Yes No Not Sure
If it does or you are not sure if it does, contact UCSF Office of Innovation, Technology & Alliance.
Will your proposed study target inclusion of subjects from special populations?
Yes No
If yes, select AT LEAST ONE from Special Category Populations that is applicable:
Pregnant women
Children (under 18)
Emancipated minors
Pregnant under 18
Homeless
Marginally housed
Transitionally housed
Unstable housing
Institutionalized - Incarcerated/prisoners
Institutionalized - Nursing home population
Institutionalized - Mental health facility
Cognitively impaired
Educationally disadvantaged
Economically/socially-disadvantaged
AIDS/HIV+
Terminally ill
Veterans
Under-represented ethnic minorities: Hispanic or Latino
Under-represented ethnic minorities: Not Hispanic or Latino
Under-represented ethnic minorities: Prefer not to Answer
Under-represented racial minorities: American Indian or Alaskan Native
Under-represented racial minorities: Asian
Under-represented racial minorities: Black or African American
Under-represented racial minorities: Native Hawaiian or Other Pacific Islander
Under-represented racial minorities: White
Under-represented racial minorities: Other
Under-represented racial minorities: Prefer not to Answer
SECTION 4
Review Process Information
SECTION 5
Proposal
Version used in RAP Spring 2018 Cycle