CEBS Voucher Program Application

Applicant Name(Required)

First

Last

Department(Required)

Position(Required)

Email(Required)

Phone(Required)

If working under the direction of a Principal Investigator (PI) , please list his or her name and department; otherwise please indicate N/A.(Required)

Project Title

In a few (1-3) sentences, explain how your proposed project will use the FaCT Core to address the CEBS COBRE theme of developing (including fabrication, characterization, testing, and validation of) sensors, devices, and/or systems for biomedical research or clinical applications(Required)

Human Subjects Research(Required)

Yes

Vertebrate Animals(Required)

Yes

Will the data generated from the use of this voucher be used in an upcoming grant application?

Yes

Estimated Project Timeline(Required)

Provide a Project Description: Upload a project description, 2 pages maximum

Max. file size: 10 MB.

Please upload the PI’s NIH Biosketch(Required)

Max. file size: 10 MB.

Please upload your budget request. If you would like a copy of the CEBS COBRE internal budget request, please contact Rhiannon Wood, Accountant, at RhiannonWood@boisestate.edu.(Required)

Max. file size: 10 MB.

Please upload quote generated from a core facilities manager(Required)

Max. file size: 10 MB.

The request is in response to the COBRE CEBS theme of biomedical devices, sensors, and systems.(Required)

I agree

If awarded the voucher, you agree to: 1) submit the required annual report, and 2) cite the CEBS COBRE in any and all publications, oral or written presentations (e.g., talks or posters), press releases, and other documents describing the projects or programs that are supported by the use of this voucher. If awarded, acknowledge voucher support by including the following information in presentations, publications, or other products that utilize results from this funding: “We acknowledge support from the Institutional Development Awards (IDeA) from the National Institute of General Medical Sciences of the National Institutes of Health under Grant #P20GM148321. We also acknowledge support from the Boise State University FaCT Core Facility.(Required)

I agree

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CEBS Voucher Program Application

Center of Biomedical Research Excellence