Senoir - Key Person Profile.pdf

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FSIS FERN Cooperative Agreement Program
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Key Personnel FORM

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Research & Related Senior/Key Person Profile D:20061211095825- 05'00' D:20061211095825- 05'00' Province:

PROFILE - Project Director/Principal Investigator Prefix:

* First Name:

Middle Name:

* Last Name:

Suffix:

Organization Name:

Division:

Position/Title:

Department:

* Street1:

Street2:

* Phone Number:

Fax Number:

* E-Mail:

Credential, e.g., agency login:

* Project Role:

Other Project Role Category:

* Zip / Postal Code:

* Country:

* State:

County:

* City:

Attach Current & Pending Support RESEARCH & RELATED Senior/Key Person Profile

* Attach Biographical Sketch Province:

PROFILE - Senior/Key Person Prefix:

* First Name:

Middle Name:

* Last Name:

Suffix:

Organization Name:

Division:

Position/Title:

Department:

* Street1:

Street2:

* Phone Number:

Fax Number:

* E-Mail:

Credential, e.g., agency login:

* Project Role:

Other Project Role Category:

* Zip / Postal Code:

* Country:

* State:

County:

* City:

Attach Current & Pending Support

* Attach Biographical Sketch

ADDITIONAL SENIOR/KEY PERSON PROFILE(S)

Additional Biographical Sketch(es) (Senior/Key Person) Additional Current and Pending Support(s) OMB Number: 4040-0001 Expiration Date: 10/31/2019 RESEARCH & RELATED Senior/Key Person Profile

Mandatory:
First Name (Senior/Key Person): Enter the first (given) name of the Project Director. This field is required.:
Prefix (Senior/Key Person): Enter the prefix (e.g., Mr., Mrs., Rev.) for the name of the Project Director.:
Middle Name (Senior/Key Person): Enter the middle name of the Project Director.:
Last Name (Senior/Key Person): Enter the last (family) name of the Project Director. This field is required.:
Suffix (Senior/Key Person): Enter the suffix (e.g., Jr, Sr, PhD) for the name of the Project Director.:
Position/Title (Senior/Key Person): Enter the title of the Project Director.:
Department (Senior/Key Person): Enter the name of primary organizational department, service, laboratory, or equivalent level within the organization of the PD/PI.:
Organization Name (Senior/Key Person): Enter the name of organization of the PD/PI.:
Street1 (Senior/Key Person): Enter the first line of the street address for the Project Director in the "Street 1" field. This field is required. :
City (Senior/Key Person): Enter the city for address of Project Director. This field is required.:
County (Senior/Key Person): Enter the county for address of Project Director.:
Division (Senior/Key Person): Enter the name of primary organizational division, office, or major subdivision of the PD/PI.:
Street2 (Senior/Key Person): Enter the second line of the street address for the Project Director in the "Street 2" field. This field is optional.:
Province (Senior/Key Person): Enter the Province where the Project Director is located.:
Credential (e.g., agency login) (Senior/Key Person): If you are submitting to an agency (e.g., NIH) where you have an established personal profile, enter the agency ID. If not, leave blank.:
Attach Current & Pending Support: Provide a list of all current and pending support for the senior/key person (even if they receive no salary support from the project(s)) for ongoing projects and pending proposals. Show the total award amount for the entire award period (including indirect costs) as well as the number of person-months per year to be devoted to the project by the senior/key person, regardless of source of support. Concurrent submission of a proposal to other organizations will not prejudice its review.:
State (Senior/Key Person): Select the state where the Project Director is located. This field is required if the Project Director is located in the United States.:
Country (Senior/Key Person): Select the country for the Project Director address. This field is required.:
ZIP Code (Senior/Key Person): Enter the postal Code (e.g., ZIP code) of Project Director. This field is required if the Project Director is located in the United States.:
Phone Number (Senior/Key Person): Enter the daytime phone number for the Project Director. This field is required.:
Fax Number (Senior/Key Person): Enter the fax number for the Project Director.:
Email Address (Senior/Key Person): Enter the e-mail address for the Project Director. This field is required for Project Director.:
Project Role (Senior/Key Person): Select one. Use "Other" if a category is not listed in the pick list. This field is required.:
Other Project Role Category (Senior/Key Person): Complete if you have selected "Other Professional" or "Other" as a project role; e.g., Engineer, Chemist.:
View Attachment: Click here to view the attachment.:
Delete Attachment: Click here to delete the attachment.:
Attach Biographical Sketch (Senior/Key Person): Provide a biographical sketch for the senior/key person. Recommended information includes: Education and Training, Research and Professional Experience, Collaborators and Affiliations (for conflicts of interest), Publications and Synergistic Activities. Save the information in a single file and attach here. This field is required.:
Attach Biographical Sketch (Senior/Key Person): Provide a biographical sketch for the senior/key person. Recommended information includes: Education and Training, Research and Professional Experience, Collaborators and Affiliations (for conflicts of interest), Publications and Synergistic Activities. Save the information in a single file and attach here. This field is required.:
Attach Current & Pending Support: Provide a list of all current and pending support for the senior/key person (even if they receive no salary support from the project(s)) for ongoing projects and pending proposals. Show the total award amount for the entire award period (including indirect costs) as well as the number of person-months per year to be devoted to the project by the senior/key person, regardless of source of support. Concurrent submission of a proposal to other organizations will not prejudice its review.:
Delete Attachment: Click here to delete the attachment.:
View Attachment: Click here to view the attachment.:
FileName:
MimeType:
href:
hashAlgorithm:
HashValue_data:
Suffix (Senior/Key Person): Enter the suffix (e.g., Jr, Sr, PhD) for the name of the Senior/Key Person.:
Middle Name (Senior/Key Person): Enter the middle name of the Senior/Key Person.:
Prefix (Senior/Key Person): Enter the prefix (e.g., Mr., Mrs., Rev.) for the name of the Senior/Key Person.:
Position/Title (Senior/Key Person): Enter the title of the Senior/Key Person.:
Organization Name (Senior/Key Person): Enter the name of organization of the Senior/Key Person.:
County (Senior/Key Person): County for address of Senior/Key Person.:
Street2 (Senior/Key Person): Enter second line of the street address for the Senior/Key Person in the "Street 2" field. This field is optional.:
Division (Senior/Key Person): Enter the name of primary organizational division, office, or major subdivision of the Senior/Key Person.:
Department (Senior/Key Person): Enter the name of primary organizational department, service, laboratory, or equivalent level within the organization of the Senior/Key Person.:
Province (Senior/Key Person): Enter the Province of Senior/Key Person.:
Country (Senior/Key Person): Select the country for the Senior/Key Person address. This field is required.: USA: UNITED STATES
DeleteEntry:
NextPage:
Credential (e.g., agency login) (Senior/Key Person): If you are submitting to an agency (e.g., NIH) where you have an established personal profile, enter the agency ID. If not, leave blank.:
Fax Number (Senior/Key Person): Enter the fax number for the Senior/Key Person.:
First Name (Senior/Key Person): Enter first (given) name of the Senior/Key Person. This field is required.:
Last Name (Senior/Key Person): Enter the last (family) name of the Senior/Key Person. This field is required.:
Street1 (Senior/Key Person): Enter first line of the street address for the Senior/Key Person in the "Street 1" field. This field is required.:
City (Senior/Key Person): City for address of Senior/Key Person. This field is required.:
State (Senior/Key Person): Enter the State where the Senior/Key Person is located. This field is required if the Senior/Key Person is located in the United States.:
ZIP Code (Senior/Key Person): Enter the Postal Code (e.g., ZIP code) of Senior/Key Person. This field is required if the Senior/Key Person is located in the United States.:
Phone Number (Senior/Key Person): Enter the daytime phone number for the Senior/Key Person. This field is required.:
Email Address (Senior/Key Person): Enter the e-mail address for the Senior/Key Person. This field is required for the Senior/Key Person.:
Other Project Role Category (Senior/Key Person): Complete if you have selected "Other Professional" or "Other" as a project role; e.g., Engineer, Chemist.:
Project Role (Senior/Key Person): Select one. Use "Other" if a category is not listed in the pick list. This field is required.: PD/PI
PrevPage:
recordno:
DataEntered:
MarkRequired:
ADDITIONAL SENIOR/KEY PERSON PROFILE(S): If more than 7 senior/key person profiles are proposed, provide the information requested in a separate file and attach here.:
Additional Biographical Sketch(es) (Senior/Key Person): Provide a biographical sketch for each senior/key person. Recommended information includes: Education and Training, Research and Professional Experience, Collaborators and Affiliations (for conflicts of interest), Publications and Synergistic Activities. Save the information in a single file and attach here.:
Additional Current and Pending Support(s): Provide a list of all current and pending support for the PI and each senior/key person (even if they receive no salary support from the project(s)) for ongoing projects and pending proposals. Show the total award amount for the entire award period (including indirect costs) as well as the number of person-months per year to be devoted to the project by the senior/key person, regardless of source of support. Concurrent submission of a proposal to other organizations will not prejudice its review.:
ADDITIONAL SENIOR/KEY PERSON PROFILE(S): If more than 7 senior/key person profiles are proposed, provide the information requested in a separate file and attach here.:
Delete Attachment: Click here to delete the attachment.:
View Attachment: Click here to view the attachment.:
Additional Biographical Sketch(es) (Senior/Key Person): Provide a biographical sketch for each senior/key person. Recommended information includes: Education and Training, Research and Professional Experience, Collaborators and Affiliations (for conflicts of interest), Publications and Synergistic Activities. Save the information in a single file and attach here.:
Delete Attachment: Click here to delete the attachment.:
View Attachment: Click here to view the attachment.:
Additional Current and Pending Support(s): Provide a list of all current and pending support for the PI and each senior/key person (even if they receive no salary support from the project(s)) for ongoing projects and pending proposals. Show the total award amount for the entire award period (including indirect costs) as well as the number of person-months per year to be devoted to the project by the senior/key person, regardless of source of support. Concurrent submission of a proposal to other organizations will not prejudice its review.:
Delete Attachment: Click here to delete the attachment.:
View Attachment: Click here to view the attachment.:
CloseForm:
GotoPreviousPage:
GotoNextPage:
PrintButton:
AboutButton:

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