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Providence/Boston CFAR
Core Services Request Form
BIOBEHAVIORAL SCIENCES CORE (Core E)
Investigator Information:
First Name
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Last Name
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Gender:
Male
Female
Email Address
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Phone Number
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Academic Affiliation
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Boston University (Charles River Campus)
Boston University Medical Campus (BUMC)
Boston Medical Center (BMC)
Brown University
Tufts University
Other
Other
Investigator Level (Select one)
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Category 1: NIH Independent Investigator-Individuals who have ever been the PI on an R01 equivalent grant in HIV/AIDS (R01 equivalents include R01, R23, R29, R37 and after 2008 DP2)
Category 2: NIH Independent Investigator-Individuals who are or have ever been the PI on an R01 equivalent grant, but never in HIV/AIDS
Category 3: NIH New Investigator-Individuals who have received funding as a PI directly from NIH, but not yet at the R01 equivalent level (i.e. K, R34)
Category 4: CFAR Users who have not yet received direct funding from NIH as a PI or Co-PI funding on any NIH grant mechanism (including post doc or research fellow)
Other: Including lab staff, community members and undergraduate or graduate students
Special Emphasis Categories (Select all that apply)
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Category 5: Current recipient of Developmental Core awards, salary support, mentoring, and/or other services
Category 6: Current recipient of NIH/CFAR Administrative Supplement funds
Category 7: Member of an Underrepresented Group in Research (African American, Hispanic, American Indian,
Category 8: Woman
None
Type of service being requested:
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Access to domestic populations of HIV-infected persons and persons at-risk for HIV-infection (participant recruitment, enrollment and retention to advance biobehavioral research.
Access to international populations of HIV-infected persons and persons at-risk for HIV-infection (participant recruitment, enrollment and retention to advance biobehavioral research.
Support for participant engagement.
Human subjects and ethical conduct of research.
Intervention design, implementation, evaluation.
Implementation science and economic analysis.
Other
Other
Please provide a brief description of the service requested.
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What type of grant are services being requested for:
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NIH Grant
NIH Administrative Supplement
Non-NIH Federal Grant
New Grant (not yet funded)
Institutionally supported project
CFAR Developmental Project
Other
NIH Grant Number
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NIH Grant Title
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Sponsor Name
(Non-NIH Federal Grant)
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Grant Number
(Non-NIH Federal Grant)
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Title
(Non-NIH Federal Grant)
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Title
(NIH Administrative Supplement)
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FY Funded (NIH Administrative Supplement)
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Sponsor Name
(New Grant Application)
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Title
(New Grant Application)
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Sponsor Name-TMH, Brown, BU, etc.
(Institutionally supported project)
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Title
(Institutionally support project)
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Is this a funded CFAR Developmental project
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Yes
No
Title
(CFAR Developmental project)
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Sponsor
(Fondation or Industry)
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Title
(Other - Foundation or Industry)
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