Proposal Description Information Questionnaire *This form is for internal use only, within the Department of Pharmacology & Therapeutics* PI Name(Required) First Last Email(Required) Agency solicitation number/RFA number:(Required) Proposal title (if known): Application Type:(Required) New Resubmission Renewal Continuation What is the previous cycle grant number? 1. Will you be using live vertebrate animals?(Required) Yes No Will animal be euthanized and is the method consistent with American Veterinary Medical Association (AVMA) guidelines?(Required) Yes No 2. Will you be using human subjects [including human data or tissue or collection of data through surveys]?(Required) Yes No Are the participants prospectively assigned to an intervention?(Required) Yes No Is the study designed to evaluate the effect of the intervention on the participants? Yes No Is the effect that will be evaluated a health-related biomedical or behavioral outcome?(Required) Yes No 3. Does any of the proposed research in the application involve human specimens and/or data?(Required) Yes No 4. Will you use only de-identified data or tissue?(Required) Yes No De-identified is either (a) anonymous or (b) coded with a confidentiality agreement.5. Does the proposed project involve human embryonic stem cells?(Required) Yes No 6. Does the proposed project involve the use of select agents?(Required) Yes No https://www.selectagents.gov/ Consortiums: Will this proposal include subcontracts/consortium(s) to another institution?(Required) Yes No Please list all proposed subcontracts/consortiums:InstitutionFirst NameLast Name Add RemovePlease list all proposed Key Personnel:RoleFirst NameLast Name Add RemoveWhen do you expect to submit(Required) MM slash DD slash YYYY
