Notice of Intent to Apply for Extramural Funding

The mission of the Department of Medicine Research Office (DRO) is to help investigators pursue and secure external funding for projects, research, scholarship, and creative activities. This form serves as notification to DRO staff that you are interested in a specific funding opportunity. When notified, we'll add your project to our work calendar, which will ensure that it has priority over late notice applications. We'll also reach out to you to coordinate proposal preparation efforts.

Please answer as many questions as you can, as accurately as possible. Information you submit on this form will help our office begin the proposal planning process. A copy of the information you enter will sent by email to you and your Division Director.

Note that pre-award services ideally require DRO staff to start working with a PI at least 30 business days before a proposal's submission deadline, with more complex proposals (e.g., grants that involve subawards, support numerous individuals, require institutional commitment) requiring greater advance notice. Late notification of an intent to apply for a grant will limit the support available from DRO. At a minimum, the Department of Medicine Research Office requires five (5) business days to review a completed proposal prior to institutional review and approval by the Office of Research and Sponsored Programs. ORSP also requires five (5) business days to process applications. Thus, once your proposal is complete, you'll need at least ten (10) business days prior to the submission date to obtain final review, approval, and signatures.

Submitting this form notifies the DRO staff of your interest in an external funding opportunity; however, it does not obligate you to prepare and submit a project to the sponsor. If you have any questions after submitting this form, please don't hesitate to reach out to our office for answers.

Contact DRO staff

• Chas Dunn - (601) 815-9055

* = Required Fields

Principal Investigator*	*
Division*	Allergy and Immunology Cardiology Digestive Diseases Endocrinology Geriatrics Hematology and Oncology Infectious Diseases Internal Medicine and Hypertension Jackson Heart Study Nephrology Pulmonary, Critical Care and Sleep Medicine Rheumatology and Molecular Immunology *
Type of Proposal*	New Revision/Resubmission Supplement Competing or Non-Competing Renewal Continuations *
For continuations and renewals only: Current Lawson activity #
Type of activity*	Clinical Trial/Study Cooperative Agreement Fellowship Grant Intramural MSDH Agreement Research Agreement Subaward Agreement Other *
Funding agency name (NHLBI, CDC, American Heart Association, HRSA, Merck, Cystic Fibrosis Foundation, etc.)*	*
Funding Agency Submission Deadline*	*Invalid Date
Will UMMC be the lead institution?*	Yes, UMMC will be the prime No, UMMC is a subaward *
Prime Institution (use only if UMMC is not the prime institution)
Prime PI (Principal Investigator at the prime institution)
When are documents due to the prime institution? (use only if UMMC is not the prime institution)	Invalid Date
Proposal Title (or working title if not final)*	*
Proposal nickname or short name
Type of program (R01, R34, U54, industry sponsored clinical trial, etc.)*	*
Solicitation number or website (PA-16-160, https://AHA/ResearchPrograms/Cardiovascular-Medicine.org, etc.)
Project Start Date*	*Invalid Date
Project End Date*	*Invalid Date
Project Location*	On Campus Off Campus Adjacent Off Campus Outside Jackson, MS *
What is the indirect cost rate used for this proposal? (Does the funding agency use a different rate than UMMC's federally negotiated indirect rate?)*	*
Is any cost share required?* Yes No *
Will UMMC require subcontractors?* Yes No *
Will any project activities involve:* Human Subjects Animal Subjects Human/Other primate tissue, blood or cells Recombinant DNA Pathogenic Organisms Radioactive Materials Laser Fluoroscopic/CT None of the Above *
If None of the Above, briefly describe activities:
Have you submitted your project to IRB?*	Yes, submitted to IRB No, not submitted to IRB Pending IRB approval *
PI UMMC Email Address*	*
PI Division Chair UMMC Email Address*	*
Contact or Study Coordinator (person to whom questions about the proposal should be addressed)*	*
Name of the person who filled out this form:*	*