Single Contact Biostats & Bioinfo Core 2023

Last Name *

First Name *

Enter your email *

Institutional Affiliation: *

Harvard T.H. Chan School of Public Health

Beth Israel Deaconess Medical Center

Boston Children's Hospital

Brigham and Women's Hospital

Broad Institute

Cambridge Health Alliance

Dana Farber Cancer Institute

Fenway Health

Forsyth Institute

Harvard Medical School

Harvard Pilgrim Health Care

Harvard T.H. Chan School of Public Health

Harvard University

Mass General Hospital

Ragon Institute of MGH, MIT and Harvard

Wyss Institute

Other

Department/Division within your Institution(s):

Your phone number (country code if needed): *

Highest Degree: *

Provide your degree: *

Job Classification:

Provide your institutional affiliation: *

WE ARE REQUIRED BY THE NIH TO GET THE FOLLOWING INFORMATION FOR ALL PROJECTS

Which statements below best describe your investigator status (select all that apply; one at minimum): *

1) 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).

2) Individuals who are or have ever been the PI on an R01 equivalent grant, but never in HIV/AIDS.

3) NIH “New Investigators,” An NIH definition that encompasses individuals who have received funding as a PI directly from NIH*, but not yet at the R01 equivalent level.

4) CFAR Users who have not yet received direct funding from NIH* as PI or Co-PI funding on any NIH grant mechanism [Individuals whose only NIH funding at the PI or PD level has come indirectly from NIH, for example via an NIH CFAR Administrative Supplement, fall into this category].

5) Recipients of Core B research funding, mentoring, and/or other services.

6) Recipients of NIH CFAR administrative supplements.

Provide additional details on your investigator status (select all that apply):

7) Members of underrepresented racial/ethnic groups in AIDS research. These include African Americans, Hispanics, American Indians, Alaska natives, native Hawaiians, and Pacific Islanders.

8) Women.

9) Individuals with disabilities (defined as those with a physical or mental impairment that substantially limits one or more major life activities, as described in the Americans with Disabilities Act of 1990, as amended. See https://extramural-diversity.nih.gov/diversity-matters/individuals-withdisabilities).

10) Individuals from disadvantaged backgrounds (see https://extramuraldiversity.nih.gov/diversity-matters/disadvantaged-backgrounds for definition).

Provide the project title for this request: *

If HIV/AIDs is not in the title, explain how the project is HIV/AIDs related:

Enter Harvard mentor's First and Last names, Email, and Institution/Department if applicable:

+-

Do you have an international mentor as well? *

Yes

No

Enter international mentor's First and Last names, Email, and Institution/Department: *

+-

Are you already working with someone on the B&B Core for this grant/project? *

Yes

No

Who are you working with? *

Provide the name of the person you are working with from the B&B Core: *

Thank you for completing this request.