Biology of GDNF in Diabetic Neuropathy

表格批准程序0g5h/2004卫生与公众服务部公共卫生服务拨款申请不得超过56个字符的长度限制，包括空格。1.糖尿病神经病变GDNF的项目生物学研究。0925-0001 Leave BLANKM仅供PHS使用，J型活动编号审查组前身为理事会/董事会(月，年)收到日期2.对申请或计划公告或招标的具体请求的回应[]否[]是(如果是，请注明州编号和标题)编号：PA-99-159标题：增长因素的作用3.首席调查员/计划主任3a。名字(最后、第一、中间)斯塔基，谢丽尔·L·3c。职位名称助理教授3E。医学院三系、服务、实验室或相关专业：细胞生物学、神经生物学与解剖学。电话和传真(区号、号码和分机)电话：414-456-8373传真：414-456-6517否[]是4c.NIH定义的第三阶段临床试验[]否[]是7.申请费用BUDGETPERIOD 7a。直接成本($)50,000 4.受试者4a研究豁免[]研究如果是，豁免否。__[]编号4b。人体受试者保证号[]是的6.建议的支持期日期(月、日、年--月/日/年)自2002年1月12日起至2007年11月30日9.申请机构名称威斯康星州医学院地址：密尔沃基水镇普兰克路26509号邮政信箱，Wi 53226-0509机构档案编号(如果知道)&6001 12.获奖将通知行政官员罗德尼·W·基森头衔主任，赠款和合同主任地址威斯康星州密尔沃基医学院邮政信箱26509，Wi 53226-0509电话：414-456-8507传真：414-456-6555电子邮件授权@rncw.edu糖尿病并发症的发展新研究员[]否[]是。学位(S)，博士3D。邮寄地址(街道，城市，州，邮政编码)威斯康星医学院细胞生物学，神经生物学和解剖学8701沃特敦普兰克路邮政信箱26509密尔沃基，威斯康星州53226-0509电子邮件地址：cstucky@mcw.edu 5.脊椎动物[]否[]是5a。如果是，则IACUC 11/15/00批准日期为5b。动物福利保证编号A-3102-01 FORINITIAL 8.拟议支助期请拨费用7b。总成本(美元)8a。直接成本($)80亿。总成本($)75,000 250,000 375,000 10.组织类型公共：--&gt；[]联邦[]州[]地方私人：--&gt；[]非营利性私人：--&gt；[]一般[]小企业[]妇女拥有的[]社会和经济上的弱势群体11.实体识别号1390806261A3 Duns No.(如果有的话)93-763-9060国会第五区13.正式签署申请机构名称威廉·亨迪，博士头衔高级协会。WL 53226-0509 WL 53226-0509电话：(414)456-4402传真：(414)456-6554EMAIL GRANTS@MCW，EDU 14.首席调查员/项目主任保证：据我所知，我证明这里的陈述是真实、完整和准确的。我知道，任何虚假、虚构或欺诈性的陈述或索赔都可能使我受到刑事、民事或行政处罚。我同意承担该项目科学实施的责任，并提供所需的进度报告，如果由于这项申请而获得资助。15申请组织认证和接受：我证明，据我所知，本申请中的陈述是真实、完整和准确的，并接受遵守公共卫生服务条款和条件的义务，如果因本申请而获得资助。我知道，任何虚假、虚构或欺诈性的陈述或索赔都可能使我受到刑事、民事或行政处罚。？PHS 398(05/01版)名为3a的PI/PD的面部签名。(用墨水。_；_/_“_i_i性质不是。t_e.._.，_，签名‘_fficative na_(墨水。”根据“签名不能接受。”)，.I页面表格第i页？========================================Section End===========================================

¿ FormApprovTehdrou0g5h/2004 Department of Health and Human Services Public Health Services Grant Application Do not exceed 56-character length restrictions, including spaces. 1. TITLE OF PROJECT Biology of GDNF in Diabetic Neuropathy OMBNo. 0925-0001 LEAVE BLANKmFOR PHS USE ONLY, Type J Activity Number Review Group Formerly Council/Board (Month, Year) Date Received 2. RESPONSE TO SPECIFIC REQUEST FOR APPLICATIONS OR PROGRAM ANNOUNCEMENT OR SOLICITATION [] NO [] YES (If "Yes," state number and title) Number: PA-99-159 Title:The Role of Growth Factors 3. PRINCIPAL INVESTIGATOR/PROGRAM DIRECTOR 3a. NAME (Last, first, middle) Stucky, Cheryl L. 3c. POSITION TITLE Assistant Professor 3e. DEPARTMENT, SERVICE, LABORATORY, OR EQUIVALENT Cell Biology, Neurobiology & Anatomy 3¿ MAJOR SUBDIVISION School of Medicine 3g. TELEPHONE AND FAX (Area code, number and extension) TEL: 414-456-8373 FAX: 414-456-6517 No [] Yes 4c. NIH-defined Phase III Clinical Trial [] No [] Yes 7. COSTS REQUESTED BUDGETPERIOD 7a. Direct Costs ($) 50,000 4. HUMAN SUBJECTS 4a. Research Exempt [] RESEARCH If"Yes," Exemption No. __ [] No 4b. Human Subjects Assurance No. [] Yes 6. DATES OF PROPOSED PERIOD OF SUPPORT (month, day, year--MM/DD/YY) From 12/01/02 J Through11/30/07 9. APPLICANT ORGANIZATION Name Medical College of Wisconsin Address 8701 Watertown Plank Road PO Box 26509 Milwaukee, WI 53226-0509 Institutional Profile File Number (if known) & 6001 12. ADMINISTRATIVE OFFICIAL TO BE NOTIFIED IF AWARD IS MADE Name Rodney W. Kison Title Director, Grants & Contracts Address Medical College of Wisconsin PO Box 26509 Milwaukee, WI 53226-0509 Tel 414-456-8507 FAX 414-456-6555 E-Mail grants@rncw.edu in the Development of Diabetes Complications Newlnvestigator [] No [] Yes 3b. DEGREE(S) PhD 3d. MAILING ADDRESS (Street, city, state, zip code) Medical College of Wisconsin Dept of Cell Biology, Neurobiology & Anatomy 8701 Watertown Plank Road PO Box 26509 Milwaukee, WI 53226-0509 E-MAIL ADDRESS: cstucky@mcw.edu 5. VERTEBRATE ANIMALS [] No [] Yes 5a. If"Yes," IACUC 11/15/00 approval Date 5b. Animal welfare assurance no A-3102-01 FORINITIAL 8. COSTS REQUESTED FOR PROPOSED PERIOD OF SUPPORT 7b. Total Costs ($) 8a. Direct Costs ($) 8b. Total Costs ($) 75,000 250,000 375,000 10. TYPE OF ORGANIZATION Public: --> [] Federal [] State [] Local Private: --> [] Private Nonprofit For-profit:--> [] General [] Small Business [] Woman-owned [] Socially and Economically Disadvantaged 11. ENTITY IDENTIFICATION NUMBER 1390806261A3 DUNS NO. (if available) 93-763-9060 Congressional District 5 13. OFFICIAL SIGNING FOR APPLICANT ORGANIZATION Name William Hendee, Ph. D. Title Sr. Assoc. Dean for Research Address Medical College of Wisconsin 8701 Watertown Plank Road PO Box 26509 Milwaukee, Wl 53226-0509 Tel (414) 456-4402 FAX (414) 456-6554 E-Mail grants@mcw, edu 14. PRINCIPAL INVESTIGATOR/PROGRAM DIRECTOR ASSURANCE: I certify that the statements herein are true, complete and accurate to the best of my knowledge. I am aware that any false, fictitious, or fraudulent statements or claims may subject me to criminal, civil, or administrative penalties. I agree to accept responsibility for the scientific conduct of the project and to provide the required progress reports if a grant is awarded as a result of this application. 15 APPLICANT ORGANIZATION CERTIFICATION AND ACCEPTANCE: I certify that the statements herein are true, complete and accurate to the best of my knowledge, and accept the obligation to comply with Public Health Services terms and conditions if a grant is awarded as a result of this application. I am aware that any false, fictitious, or fraudulent statements or claims may subject me to criminal, civil, or administrative penalties. ¿ PHS 398 (Rev. 05/01) Face SIGNATURE OF PI/PD NAMED IN 3a. (In ink. _;_/_" _i_Inature not aocep.t_e._ .,_ , SIGNATURE OF'_FFICIAL NA_ (In ink. "Per" signature not acceptable.) ,.i Page Form Page I ¿ ========================================Section End===========================================