R Club Intake Form

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As a collaborative effort between UC's College of Medicine Office of Research and the Center for Clinical and Translational Science and Training (CCTST), we have developed the R Club Grant Program to assist early-stage investigators in the preparation of an NIH Research Grant.

The R Club aims to improve grantsmanship by promoting clarity of thought and logical presentation of a Research proposal - to have the greatest impact on fundability - by providing:

Workshops outlining a step-by-step guide on how to construct a Specific Aims page and a
competitive Research Proposal.
Proposal examples and templates of supporting documents.
Constructive feedback on a Specific Aims page (with tracked revisions, margin comments, and key recommendations).
For a select cohort, comprehensive proposal review of scientific and logical presentation of content (with tracked revisions, margin comments, and key recommendations) by a grant writer.

Eligibility: To be eligible for the R Club Grant Program, applicants must have a full-time junior faculty appointment and be a member of UC's College of Medicine and/or the CCTST. Applicants must be preparing an original or re-submission application that could ultimately lead to the funding of their first major NIH Research proposal.

CCTST Membership: All participants of the R Club Grant Program must be CCTST members. CCTST membership is free and open to all. For online membership registration, go to https://cctst.uc.edu/user/register.

Timeline: The R Club Grant Program is available year-round. To take full advantage of the multi-level grant writing support, it is advised to submit this form a minimum of 4 months prior to your internal grant deadline.

NAME (Last, First, Middle)

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EMAIL ADDRESS

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DEGREES (Please check any that you have)

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PhD

PharmD

Other

If Other Degree, please describe here:

POSITION TITLE (Please check all that apply)

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Professor

Associate Professor

Assistant Professor

Department/Division Chair

Other

If other, please describe here:

Please indicate your PRIMARY institutional affiliation:

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University of Cincinnati

UC Health

Cincinnati Children's Hospital Medical Center

Cincinnati VA

Other

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If other, please describe here:

Are you a CCTST member?

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Yes

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BECOME A CCTST MEMBER TODAY!

Register here at cctst.uc.edu/user/register to unlock these and many other perks!

CCTST Membership includes:

Consultations and access to programs.
Resources for researchers, community members, and research coordinators.
Research tools ranging from planning and design to data analysis.
Access to events and education opportunities.
Extensive funding opportunities.

CCTST members can benefit from most of the services above at no cost.

DEPARTMENT/DIVISION

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CHAIR NAME (Last, First, Middle)

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CHAIR E-MAIL ADDRESS

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ANTICIPATED GRANT MECHANISM APPLYING FOR:

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NIH R01

NIH other R Series (Please specify )

NIH K Series (Please specify)

Other (Please specify)

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If other grant mechanism, please specify:

Please enter your anticipated date of grant submission (MM/YYYY):

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ANTICIPATED DATE OF SUBMISSION

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June 2021

October 2021

2022

October 2022

February 2023

June 2023

October 2023

Other

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STATUS OF GRANT SUBMISSION

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Original

Re-submission; Not Discussed

Re-submission; Score Received

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Please provide the "priority score:"

Please provide the "percentile ranking:"

HAVE YOU INTERACTED WITH YOUR PROGRAM OFFICER REGARDING THIS PROJECT?

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Yes No

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UPLOAD YOUR BIOSKETCH

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Upload file

UPLOAD A LETTER OF SUPPORT FROM YOUR CHAIR

Upload file

Please upload a description of your project here (e.g., one-page summary, poster etc.).
This is optional and not required in order to apply for the R Club.

Upload file

What is your sex/gender?

Woman

Man

Non-binary, transgender, or gender non-conforming

Prefer not to report

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What is your ethnic background?

Hispanic or Latino

Not Hispanic or Latino

Unknown or Not Reported

Do Not Wish to Provide

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What is your racial background?

American Indian or Alaska Native

Native Hawaiian or other Pacific Islander

Asian

Black or African American

White (non-Hispanic)

More Than One Race

Unknown or Not Reported

Do Not Wish to Provide

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Do you have a disability? The Americans with Disabilities Act (ADA) defines an individual with a disability as a person
with a physical or mental impairment that substantially limits one or more major life activities.

Yes

Do Not Wish to Provide

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Are you from a disadvantaged background?

Individuals from disadvantaged backgrounds are defined as those who meet two or more of the following criteria:
1. Were or currently are homeless, as defined by the McKinney-Vento Homeless Assistance Act
2. Were or currently are in the foster care system, as defined by the Administration for Children and Families
3. Were eligible for the Federal Free and Reduced Lunch Program for two or more years
4. Have/had no parents or legal guardians who completed a bachelor's degree
5. Were or currently are eligible for Federal Pell grants
6. Received support from the Special Supplemental Nutrition Program for Women, Infants and Children (WIC) as a parent or child
7. Grew up in one of the following areas: a) a U.S. rural area, as designated by the Health Resources and Services Administration (HRSA) Rural Health Grants Eligibility Analyzer or b) a Centers for Medicare and Medicaid Services-designated Low-Income and Health Professional Shortage Areas. Only one of the two possibilities in #7 can be used as a criterion for the disadvantaged background definition.

Students from low socioeconomic (SES) status backgrounds have been shown to obtain bachelor's and advanced degrees at significantly lower rates than students from middle and high SES groups, and are subsequently less likely to be represented in biomedical research.

Yes

Prefer not to report

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Is English your first language?

Yes

Prefer not to report

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