PI First Name* must provide value
PI Last Name* must provide value
PI Email* must provide value
Management Center* must provide value
SOM/SON (MNMC)
Campus (PAMC)
What department should this Proposal be routed through? (Owning Department)* must provide value
Anesthesiology Biochemistry Biostatistics & Bioinformatics Cell Biology Center for Aging DCI (Duke Cancer Institute) Dermatology DGHI (Global Health Institute) DHVI (Duke Human Vaccine Institute) DMPI (Duke Molecular Physiology Institute) FMCH (Family Medicine And Community Health) Forge Genomics and Computational Biology Heart Center Immunology Institutional/Other RASR Marcus Center Medicine MGM (Molecular Genetics and Microbiology) Neurology NSU (Neurosurgery) Ophthalmology Orthopedics Pathology Pediatrics Pharmacology and Cancer Biology Population Health Psychiatry & Behavioral Sciences Radiation Oncology Radiology
Select 'Department'.
What department should this Proposal be routed through? (Owning Department)* must provide value
A&S - Classical Studies A&S - Cultural Anthropology A&S - DevLab A&S - DUPRI A&S - Economics A&S - Education A&S - GRID A&S - GVCC A&S - Other A&S - Sociology Biodemography of Aging Divinity School Energy Initiative Fuqua Business School Margolis Center Kenan Institute for Ethics Law School Nicholas Institute Provost Office Sanford School Science and Society Social Science Research Institute Campus department not listed
Select 'Department'.
Campus department not listed, please specify:* must provide value
Select the Medicine Division* must provide value
Cardiology Cell Therapy Center for Aging and Precision Medicine Clinical Pharmacology Endocrinology Gastroenterology General Internal Medicine Geriatrics Hematological Malignancies Hematology Infectious Disease Nephrology Oncology Pulmonary Rheumatology
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Sponsor
Sponsor Due Date
M-D-Y
When is your planned submission date?
M-D-Y
Initial Date
M-D-Y
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Would you like to take advantage of ORA's Supplemental Application Support Service?
ORA - Supplemental Application Support Yes
No
FOA Number
FOA Link / URL
If applicable.
Attach FOA / Instructions
If applicable.
Please select any conditions that apply. Multi PI
Foreign Activities
Duke subaward to another organization
Duke as a Sub-Contract (i.e. Sub-Awardee)
Historical Site (i.e. Chesterfield Building)
Limited Submission
Patient Care Costs
In Kind/Cost Sharing (Not Including NIH Salary Cap)
N/A
Check all that apply.
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Please provide a brief description (or Abstract) for the project:
Does this project involve international activity or international research? Yes
No
Not Sure
In what country/countries are you planning to conduct your research/activities?
[if multiple countries, select primary country here - the next question will allow you to list other countries] TBD/Other Afghanistan - AFG Akrotiri - XQZ Albania - ALB Algeria - DZA Andorra - AND Angola - AGO Anguilla - AIA Antarctica - ATA Antigua And Barbuda - ATG Argentina - ARG Armenia - ARM Aruba - ABW Ashmore And Cartier Islands - XAC Australia - AUS Austria - AUT Azerbaijan - AZE Bahamas The - BHS Bahrain - BHR Bangladesh - BGD Barbados - BRB Bassas Da India - XBI Belarus - BLR Belgium - BEL Belize - BLZ Benin - BEN Bermuda - BMU Bhutan - BTN Bolivia - BOL Bonaire Sint Eustatius And Saba - BES Bosnia And Herzegovina - BIH Botswana - BWA Bouvet Island - BVT Brazil - BRA British Indian Ocean Territory - IOT Brunei - BRN Bulgaria - BGR Burkina Faso - BFA Burma - MMR Burundi - BDI Cabo Verde - CPV Cambodia - KHM Cameroon - CMR Canada - CAN Cayman Islands - CYM Central African Republic - CAF Chad - TCD Chile - CHL China - CHN Christmas Island - CXR Clipperton Island - CPT Cocos (Keeling) Islands - CCK Colombia - COL Comoros - COM Congo (Brazzaville) - COG Congo (Kinshasa) - COD Cook Islands - COK Coral Sea Islands - XCS Costa Rica - CRI Côte D¿ivoire - CIV Croatia - HRV Cuba - CUB Curaçao - CUW Cyprus - CYP Czechia - CZE Denmark - DNK Dhekelia - XXD Diego Garcia - DGA Djibouti - DJI Dominica - DMA Dominican Republic - DOM Ecuador - ECU Egypt - EGY El Salvador - SLV Equatorial Guinea - GNQ Eritrea - ERI Estonia - EST Eswatini - SWZ Ethiopia - ETH Europa Island - XEU Falkland Islands (Islas Malvinas) - FLK Faroe Islands - FRO Fiji - FJI Finland - FIN France - FRA French Guiana - GUF French Polynesia - PYF French Southern And Antarctic Lands - ATF Gabon - GAB Gambia The - GMB Gaza Strip - XGZ Georgia - GEO Germany - DEU Ghana - GHA Gibraltar - GIB Glorioso Islands - XGL Greece - GRC Greenland - GRL Grenada - GRD Guadeloupe - GLP Guatemala - GTM Guernsey - GGY Guinea - GIN Guinea Bissau - GNB Guyana - GUY Haiti - HTI Heard Island And Mcdonald Islands - HMD Honduras - HND Hong Kong - HKG Hungary - HUN Iceland - ISL India - IND Indonesia - IDN Iran - IRN Iraq - IRQ Ireland - IRL Isle Of Man - IMN Israel - ISR Italy - ITA Jamaica - JAM Jan Mayen - XJM Japan - JPN Jersey - JEY Jordan - JOR Juan De Nova Island - XJN Kazakhstan - KAZ Kenya - KEN Kiribati - KIR Korea North - PRK Korea South - KOR Kosovo - XKS Kuwait - KWT Kyrgyzstan - KGZ Laos - LAO Latvia - LVA Lebanon - LBN Lesotho - LSO Liberia - LBR Libya - LBY Liechtenstein - LIE Lithuania - LTU Luxembourg - LUX Macau - MAC Madagascar - MDG Malawi - MWI Malaysia - MYS Maldives - MDV Mali - MLI Malta - MLT Martinique - MTQ Mauritania - MRT Mauritius - MUS Mayotte - MYT Mexico - MEX Moldova - MDA Monaco - MCO Mongolia - MNG Montenegro - MNE Montserrat - MSR Morocco - MAR Mozambique - MOZ Namibia - NAM Nauru - NRU Nepal - NPL Netherlands - NLD New Caledonia - NCL New Zealand - NZL Nicaragua - NIC Niger - NER Nigeria - NGA Niue - NIU Norfolk Island - NFK North Macedonia - MKD Norway - NOR Oman - OMN Pakistan - PAK Panama - PAN Papua New Guinea - PNG Paracel Islands - XPR Paraguay - PRY Peru - PER Philippines - PHL Pitcairn Islands - PCN Poland - POL Portugal - PRT Qatar - QAT Reunion - REU Romania - ROU Russia - RUS Rwanda - RWA Saint Barthelemy - BLM Saint Helena Ascension And Tristan Da Cunha - SHN Saint Kitts And Nevis - KNA Saint Lucia - LCA Saint Martin - MAF Saint Pierre And Miquelon - SPM Saint Vincent And The Grenadines - VCT Samoa - WSM San Marino - SMR Sao Tome And Principe - STP Saudi Arabia - SAU Senegal - SEN Serbia - SRB Seychelles - SYC Sierra Leone - SLE Singapore - SGP Sint Maarten - SXM Slovakia - SVK Slovenia - SVN Solomon Islands - SLB Somalia - SOM South Africa - ZAF South Georgia And South Sandwich Islands - SGS South Sudan - SSD Spain - ESP Spratly Islands - XSP Sri Lanka - LKA Sudan - SDN Suriname - SUR Svalbard - XSV Sweden - SWE Switzerland - CHE Syria - SYR Taiwan - TWN Tajikistan - TJK Tanzania - TZA Thailand - THA Timor Leste - TLS Togo - TGO Tokelau - TKL Tonga - TON Trinidad And Tobago - TTO Tromelin Island - XTR Tunisia - TUN Turkey - TUR Turkmenistan - TKM Turks And Caicos Islands - TCA Tuvalu - TUV Uganda - UGA Ukraine - UKR United Arab Emirates - ARE United Kingdom - GBR United States - USA Uruguay - URY Uzbekistan - UZB Vanuatu - VUT Vatican City - VAT Venezuela - VEN Vietnam - VNM Virgin Islands British - VGB Wallis And Futuna - WLF West Bank - XWB Western Sahara - ESH Yemen - YEM Zambia - ZMB Zimbabwe - ZWE
Please explain TBD/Other selection:
Will you be conducting research/activities in additional countries? Yes
No
Please list additional countries:
Please mark which of the following apply to your work (select all that apply).
Using Duke funds for you or a Duke team member to hire and directly pay local staff either as a contractor, staff member, or a casual day laborer
Opening a local bank account to support any disbursement needs, or to receive revenue from a local Sponsor
Buying or leasing vehicles
Leasing office or residential space
Engaging in human or animal subject activities, clinical research, and/or clinical trials
Having any Duke faculty, staff members, or students spend significant time (i.e., more than 4 months) in a foreign country in an individual calendar year while supporting your project
None of the above apply to my work
Have you identified a trusted in-country partner that can support the in-country activity you need? Yes
No
Please describe:
Does this project involve the collection, or use, of data? Yes
No
Not Sure
Please mark which of the following apply to the data in this project:
Using existing Duke internal/administrative or Duke Health data
Data will be collected and/or stored at Duke
Data will be received and/or accessed from external source(s) - this includes partner institutions, companies, social media sites/web, government entities
Data will be shared with an entity or person outside of Duke
Other/None of the above apply to my work
Please describe the reason that the data needs protected storage and computing environments:
"Other/None of the above apply to my work" Please describe why:
Does this project involve technologies, including mobile and web applications, websites, etc. (includes developing apps/websites as part of a project, using other apps/websites) Yes
No
Not Sure
Please describe briefly.
Note: Please consult with the appropriate Duke resource(s) prior to any purchase or entering into any third-party agreement to learn about your options and actions to comply with Duke's policies and guidelines. If you have questions please contact myresearchnavigators@duke.edu.
Does this project involve computational resources or specialized storage needs? Yes
No
Not Sure
Please briefly describe:
Does this project involve investigational drugs, biologics, devices, and/or tobacco products, which would include, for example, a completely novel product or an FDA-approved product off label. Yes
No
Not Sure
Do you plan to consent participants electronically? Yes
No
Do you plan to collect data electronically (as opposed to on paper)? Yes
No
Does this project involve shipping or receiving biological specimens, hazardous materials, or any item that may have restrictions? Yes
No
Not Sure
Please describe:
Does this project involve the use of a Duke core facility, or other space/service/procedure provided by another department? (e.g., Regional Biocontainment Laboratory, shared resource, etc.) Yes
No
Not Sure
Please describe:
Would you/the PI like a 10-15 minute project planning consultation to ensure awareness of resources that can benefit your project, and answer any questions you may have? The consultation will be completed by the myRESEARCHnavigators team. * must provide value
Yes
No
Do you have any additional information, comments, considerations to share with your grant manager or central offices at Duke?
Are you completing this form on behalf of the PI?* must provide value
Yes
No
Select one.
First Name* must provide value
Last Name* must provide value
Email* must provide value
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