UW Radiation Medicine & Accuray Pilot Application Form

Required application templates

Accuray budget template

UW Radiation Medicine and Accuray Pilot Application (Due June 26)

Please fill out this online form to apply for UW Radiation Medicine and Accuray Pilot Application.

"*" indicates required fields

Step 1 of 4

Phone

This field is for validation purposes and should be left unchanged.

Proposal title*

PI Name*

First Last Degree(s)

Faculty title*

PI Department*

PI Email*

Key Personnel

Key personnel (if applicable)

(Click the "+" for additional lines.)

Last name

First name

Department/Accuray affiliation

Role

Abstract and Research Strategy

Please complete the sections below. The (1) Research Plan, (2) References Cited, (3) Detailed Timeline, (4) Statement of Potential Impact, (5) Biosketches for all key personnel and other file uploads will be requested on the FINAL page of the online application.

Scientific Abstract*

Lay Abstract*

Limit 1500 characters.

Accuray Resource Requirements*

Describe Accuray resource requirements, or note "Not applicable"

Personnel

Software

Other (describe)

Budget

I understand the following budget restrictions apply (select all):*

Office supplies and other indirect charges are not permitted.

PI must commit minimum 1% effort (may be covered through department funds)

Funding is contingent on milestones being met.

Anticipated Project Period (years)*

Projects may span a period of up to 5 years. Annual budget allocations will typically range from $25,000-$500,000, contingent upon the scope and complexity of the proposed projects.

Please enter a number from 1 to 5.

Total requested budget (Year 1)*

Describe TOTAL budget requested (direct costs + indirect costs) for Period 1.

Total budget requested*

Enter TOTAL budget requested for full project period.

Departmental budget approval*

Please confirm the following statement.

The Department of Radiation Medicine administrator has reviewed and approved the budget.

Milestones for study and budget*

Detail the timeline for this study and budget for the total project period, including milestones and deliverables. Please note: future funding will be contingent on meeting the milestones. Annual budget allocations will typically range from $25,000-$500,000, contingent upon the scope and complexity of the proposed projects in each year.

Year (1, 2, 3, etc.)

Budget Requested

Milestone Description

Deliverable Description

File Uploads

Biosketches

PI Biosketch*

Accepted file types: pdf, doc, docx, Max. file size: 31 MB.

Key Personnel Biosketch(es)

Provide an NIH Biosketch for each person listed as key personnel.

Drop files here or

Accepted file types: pdf, doc, docx, Max. file size: 31 MB.

Research Plan

Research Plan (4 pages)*

Limit 4 pages, 1/2 inch margins. Include: (A) Title; (B) Background; (C) Purpose & Objectives; (D) Methods (including statistical plan), (E) Anticipated Challenges; and (F) Relevance to Research Pillars.

Accepted file types: pdf, doc, docx, Max. file size: 31 MB.

References cited*

Accepted file types: pdf, doc, docx, Max. file size: 31 MB.

Statement of Potential Impact (1 page)*

In one page, describe the potential impact to: (1) career development, (2) UWSMPH Department of Radiation Medicine and UW Health, (3) Accuray, and (4) patients.

Accepted file types: pdf, doc, docx, Max. file size: 31 MB.

Detailed Timeline*

Detailed timeline for study AND budget, including milestones and deliverables.

Accepted file types: pdf, doc, docx, Max. file size: 31 MB.

Accuray Resource Requirements (if applicable)

Describe all Accuray Resources required for the project, including personnel, software, etc.

Accepted file types: pdf, doc, docx, Max. file size: 31 MB.

Budget

Budget detail*

Please use template provided by Department of Radiation Medicine administrator.

Accepted file types: pdf, xls, xlsx, Max. file size: 31 MB.

Budget Justification*

Specific description of how the funds will be used: PERSONNEL, SUPPLIES, OTHER DIRECT COSTS. Please use template provided by Department of Radiation Medicine administrator.

Accepted file types: pdf, doc, docx, Max. file size: 31 MB.

Other

LOS (if applicable)

Please upload any relevant letters of support.

Drop files here or

Accepted file types: pdf, doc, docx, Max. file size: 31 MB.

Human Subjects Protocol*

Please upload your human subjects protocol if drafted, under review, or approved.

Drop files here or

Max. file size: 31 MB.

Required application templates

UW Radiation Medicine and Accuray Pilot Application (Due June 26)

Key Personnel

Research Pillars

Protocol Assurances

Abstract and Research Strategy

Budget

File Uploads

Biosketches

Research Plan

Budget

Other