Johns Hopkins Center for AIDS Research Core Service Transaction Form

Required NIH Reporting Information for CFAR Program Users and Affiliates.

First Name *

Last Name *

Email Address *

JHED ID *

What is your primary area of research? *

Behavioral and Social Sciences

Clinical

Immunology, Virology, Microbiology

Prevention

Epidemiology

Biostatistics

Community

Other:

Investigator Level *

Please select one

NIH Independent Investigator (HIV/AIDS R01 funding or equivalent)

NIH Independent Investigator (Non-HIV/AIDS R01 funding or equivalent)

NIH New Investigator (Have received funding as a PI directly from the NIH, but not yet at the R01 equivalent level)

Faculty member with no history of (non-CFAR) NIH funding

Post doc or Research Fellow

Staff

Undergraduate or Graduate Student

NIH Special Emphasis Category:

Please select any that apply

Recipient of a CFAR Faculty Development Award, mentoring or other CFAR services

Recipient of NIH CFAR administrative supplement

Under-represented group in HIV/AIDs research (African-American, Hispanic, Native American, Alaska native, native Hawaiian, Pacific Islander

Women

Please select the program in which you are reporting your involvement or requesting services *

You can select multiple programs.

Administrative Core

Biostatistics, Epidemiology and Methods Core

Clinical Core

Clinical Laboratory and Biomarkers Core

Developmental Core

Prevention Core

Required

Describe what you are requesting assistance with or what services were provided *

(i.e. Calculating sample size, locating a particular assay, looking for an exisitng questionnaire, help in recruiting subjects, etc.)

Are you requesting assistance on a currently funded grant? *

If yes, please indicate if it is related to HIV/AIDS and whether it is NIH-funded.

Yes (HIV/AIDS-related, NIH-funded)

Yes (HIV/AIDS-related, non-NIH-funded)

Yes (non-HIV/AIDS-related, NIH-funded)

Yes (non-HIV/AIDS-related, non-NIH-funded)

No, project is not currently funded.

Funding division (if NIH-funded) or funding source (if non-NIH-funded): *

If not currently funded, write "n/a."

Grant title (if currently funded) or project title (if not currently funded): *

Grant number (if applicable):

Is there a date that you require assistance by? *

(i.e. application deadline, etc.)

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