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Colorado State University ? Pueblo Institute of Cannabis Research Grant Application

2019-2020 1. Title of Proposal:

2. Faculty member/Principal Investigator:

Last Name

First Name

Middle Initial

Department:

College:

Phone:

3. Institutional Review Boards

A. Will human subjects or data be used or tested?

______Yes ______No

If yes, what is the status of IRB review? ______complete _____ document enclosed ____ pending

Have you completed any formal IRB training? If yes, what and when?

______Yes ______No

B. Will vertebrate animals be used? ______Yes ______No

If yes, what is the status of IACUC review? ______complete _____ document enclosed ____ pending

If yes, what animals (species) will be used, and how many?

C. Is there any research involving recombinant DNA or hazardous materials (e.g. carcinogens, pathogens, ionizing radiation) requiring review by the Institutional Biosafety Committee? ______Yes ______No

D. Have you received any training from the Colorado Department of Agriculture related to hemp?

______Yes ______No

If yes, what and when?

E. Will the proposed research project involve special requirements such as schedule I license, hemp growth/production, or use of plant (cannabis) material?

______Yes ______No

4. Space Needs for Project Will new or modified space be needed to complete the proposed research? ____ Yes ____No If yes, please briefly explain your plan for getting approval for the space.

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5. Applicant Conflict of Interest Disclosure

The purpose of this section is to give grant applicants an opportunity to disclose any conflicts of interest, or potential for conflicts of interest that exist. The applicant is not required to explain the reason for the conflict, however it is helpful. A disclosure does not automatically result in the grant application being removed from the review process. Please read the descriptions below and mark the appropriate boxes that pertain to you and any co-PIs for this proposal.

A conflict of interest occurs when someone in a position of trust has competing professional and personal interests and these competing interests make it difficult to fulfill their professional duties impartially. A conflict of interest exists even if no unethical or improper act results from it. Conflicts of interest may be actual or perceived. An actual conflict of interest occurs when a decision or action would be compromised without taking immediate appropriate action to eliminate the conflict. A perceived conflict of interest is any situation in which a reasonable person would conclude that conflicting duties or loyalties exists.

An individual conflict of interest occurs when any of the following conditions is present: a. A PI or co-PI uses their status to obtain special advantage, benefit, or access to the CSU-Pueblo's Institute of Cannabis Research time, services, facilities, equipment, supplies, prestige, or influence. b. A PI or co-PI receives or accepts money or anything else of value from an organization involved with growing, processing or distributing federally illegal cannabis. c. A PI or co-PI's objectivity in carrying out the grant is or might be otherwise impaired due to competing duties or loyalties

I certify that I have read and understand the description of individual conflict of interest above and (check one of the following two lines):

_____Based on the criteria and description above I, or to the best of my knowledge any of the Key Personnel, have no conflicts of interest. _____Based on the criteria and description above I, or to the best of my knowledge one or more of the Key Personnel, have an actual or potential conflict of interest, or the appearance of a conflict of interest, which I am listing immediately below.

Name/Relationship and/or description of the conflict of interest (attach additional page if needed):

6. Call for Submissions (Policies and Processes)

The PI and Co-PIs are responsible to review the Call for Submissions, which contains important policies and processes governing research funding through the ICR. By the PI signing the following page of this application they are agreeing to abide by the policies and processes outlined in the Call for Submissions on behalf of themselves as well as any Co-PIs collaborating on the project.

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Faculty member/ Principal Investigator

Department Chair

Signature Signature

Dean

______________________________

Signature

Date

Date

__________________

Date

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Abstract (500 words or less)

State your project's broad objectives and specific aims. Describe concisely the research design and methods for achieving these goals. The description is meant to serve as a succinct and accurate description of the proposed work when separated from the application.

Applications for professional development and/or travel proceed directly to the budget pages starting on Page 11.

Key Personnel Name

Organization/Department

Role on Project

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Background/Introduction to Problem/Project (Do not exceed two pages)

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