O’Brien Center Opportunity Pool Award X/TwitterThis field is for validation purposes and should be left unchanged.Applicant InformationYou must have the approval of a PI from the O’Brien Center to which you are applying in order to complete this application. Contact Dr. Kristina Penniston (penn@urology.wisc.edu), Interactions Coordinator for the U54 George M. O’Brien Centers, if you have any questions.Applicant's Name(Required) First Middle Last Applicant's Institution Name(Required)Institution Address(Required) Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Applicant's Telephone(Required)Applicant's Email(Required) Enter Email Confirm Email Applicant's Position(Required) Early investigator (within 10 years of terminal degree or initial academic appointment) K scholar Established investigator new to non-malignant urology Other To which O'Brien Center is the applicant submitting?(Required) Columbia University Stanford University Which of the following best describes you?(Required) Female Male Other Prefer not to answer What is your race or ethnicity? (Check all that apply)(Required) White- For example, German, Irish, English, Italian, Polish, French, etc. Hispanic, Latinx, or Spanish origin- For example, Mexican or Mexican American, Puerto Rican, Cuban, Salvadoran, Dominican, Colombian, etc. Black or African American- For example, African American, Jamaican, Haitian, Nigerian, Ethiopian, Somali, etc. Asian- For example, Chinese, Filipino, Indian, Vietnamese, Korean, Japanese, Pakistani, etc. American Indian or Alaska Native- For example, Navajo Nation, Blackfeet Tribe, Mayan, Aztec, Native Village of Barrow Inupiat Traditional Government, Nome Eskimo Community, etc. Middle Eastern or North African- For example, Lebanese, Iranian, Egyptian, Syrian, Moroccan, Algerian, etc. Native Hawaiian or Other Pacific Islander- For example, Native Hawaiian, Samoan, Chamorro, Tongan, Fijian, Marshallese, etc. Other Prefer not to answer Do you have a physical or mental impairment that substantially limits one or more major life activities, as described in the Americans with Disabilities Act of 1990?(Required) Yes No Don’t know Prefer not to answer Do you meet two or more of the disadvantaged background criteria below?(Required) Yes No Don’t know Prefer not to answer Individuals from disadvantaged backgrounds are defined by the NIH as those who meet two or more of the following criteria: *Were or currently are homeless, as defined by the McKinney-Vento Homeless Assistance Act *Were or currently are in the foster care system, as defined by the Administration for Children and Families *Were eligible for the Federal Free and Reduced Lunch Program for two or more years *Have/had NO parents or legal guardians who completed a bachelor’s degree (see First-Generation and Continuing-Generation College Students: A Comparison of High School and Postsecondary Experiences *Were or currently are eligible for Federal Pell grants Received support from the Special Supplemental Nutrition Program for Women, Infants and Children (WIC) as a parent or child *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 AreasFile Upload Check List(Required) Face Page (PHS or similar) (1 page) Specific Aims (1 page) Research Strategy (include Background/Significance, Innovation, Approach, and Preliminary data; 6 pages total) Statement – Statement detailing planned collaboration with parent O’Brien Center and utilization of existing Center resources (e.g., Cores or other) and proposed pathway for resulting findings to allow development of future investigator-initiated grant application (e.g. R01) (1 page) Detailed Budget Page for Initial Budget Period (1 page) Budget for Entire Proposed Budget Period (1 page) Budget Justification (personnel and other, as needed; unlimited) NIH Formatted Biographical Sketches – NIH formatted Biographical Sketches for collaborating O’Brien Center PI and for applicant (limit to 5 pages total for each Bio) Letter of Support from O’Brien Center PI or O’Brien Center PI signature on Statement of Collaboration Please check the boxes to confirm you have included all the required documents in your application. Note that SPECIFIC AIMS and RESEARCH STRATEGY pages should be in font size no less than 10 and with margins no less than 0.5 inchesLetters of support and other documents (optional) Letters of support Other attachment(s) Please check the boxes indicating the additional documents you have included in your application. Main Application File Upload(Required)Accepted file types: pdf, Max. file size: 2 MB. Please upload a PDF file that includes: 1. Face Page 2. Specific Aims 3. Research Strategy 4. Statement detailing planned collaboration 5. Detailed Budget Page 6. Budget for Entire Proposed Budget Period 7. Budget Justification 8. NIH Formatted Biographical Sketches. If you have a Microsoft Word document, please go to File, Save As, and choose the PDF option in the File Format dropdown list. File size limit 2,000 KBSupporting Documents File UploadAccepted file types: pdf, Max. file size: 2 MB. Please upload a separate PDF file that includes: 1. Letter of Support from O’Brien Center PI 2. Optional materials (e.g., timeline, letters of support/collaboration, etc.). If you have a Microsoft Word document, please go to File, Save As, and choose the PDF option in the File Format dropdown list. File size limit 2,000 KB