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* 1. PI Name

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* 2. Degrees

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* 3. Academic title

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* 4. University/School - Primary Appointment

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* 5. Department

The JHU, Penn, and DC CFARs are committed to improving the representation of underrepresented minorities, women, and LGBTQIA faculty within the CFAR as it relates to career development activities, leadership opportunities, and faculty recruitment. In order to evaluate our progress, we appreciate your cooperation in completing the following questions. All responses will be kept confidential and used in the aggregate.

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* 6. Current Gender

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* 7. Sex assigned at birth:

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* 8. What is your racial background?
*Please select all boxes with which you identify.

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* 9. What is your ethnicity?

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* 10. Are you disabled?
Defined as those with a physical or mental impairment that substantially limits one or more major life activities, as described in the Americans with Disabilities Act of 1990, as amended.  See NSF data

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* 11. Are you from a Disadvantaged Background
If individual meets two or more of the following criteria:
1) Were or currently are homeless, as defined by the McKinney-Vento Homeless Assistance Act (Definition);
2) Were or currently are in the foster care system, as defined by the Administration for Children and Families (Definition);
3) Were eligible for the Federal Free and Reduced Lunch Program for two or more years (Definition);
4) Have/had no parents or legal guardians who completed a bachelor’s degree (see);
5) Were or currently are eligible for Federal Pell grants (Definition);
6) Received support from the Special Supplemental Nutrition Program for Women, Infants and Children (WIC) as a parent or child (Definition).
7) 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 Areas. Only one of the two possibilities in #7 can be used as a criterion for the disadvantaged background definition.

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* 12. Project Title

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* 13. Location of the Project
International Studies will require NIH clearance

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* 14. Proposed Mentors

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* 15. Have you ever conducted HIV/AIDS Research?

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* 16. Have you ever received NIH funding for HIV research?
If yes and at an R01 level, you are not eligible to apply for a MACC Scholar award.

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* 17. Date of Terminal Degree (To assess Early-staged investigator status)
You may enter 01 for month or day if unknown.

Date

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* 18. Have you submitted an application for funding for the project described in this application to another program in addition to the CFAR?
If yes and the other funding comes through, you will be asked to return any unspent CFAR funds.

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* 19. Other potential funding source:

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* 20. Does this project involve Human Subjects?
Please use the Quick Decision Tool at https://grants.nih.gov/policy/humansubjects/hs-decision.htm. Copy and paste the determination results into the comment section below. THIS IS ESPECIALLY IMPORTANT FOR THOSE USING EXISTING DATA, AS SOME SUCH STUDIES ARE STILL CONSIDERED HSR and the NIH has special reporting requirements for HSR studies. If you do not fill in the results of the Quick Decision Tool, we will consider rejecting your application.

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* 21. Are the participants prospectively assigned to an intervention?

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* 22. Is the study designed to evaluate the effect of the intervention on the participants?

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* 23. Is the effect being evaluated a health-related biomedical or behavioral outcome?

If the answer is "yes" to questions 25 - 27 above, then this study would be considered a clinical trial according to the NIH definition and is not fund-able by the CFAR.

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* 24. Does this project involve new drugs, treatments or devices, off-label use of a licensed drug (this includes healthy volunteers) or any form of randomization?
If yes, this study is NOT allowed through the CFAR

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* 25. Does this study involve licensed drugs, treatments or devices?
If so, the project will require additional NIH review prior to starting. Please see the CFAR website for more information.

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* 26. Does this study include vulnerable populations? This includes pregnant women, neonates, fetuses, prisoners, children (<18 years of age), refugees, sex workers. 
If so, the project will require additional NIH review prior to starting. Please see the CFAR website for more information.

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* 27. Does this study involve procedures or behavioral interventions deemed above minimal risk by the IRB?
If so, the project will require additional NIH review prior to starting. Please see the CFAR website for more information.

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* 28. Does this study involve vertebrate animals?
If so, IACUC approval will be required.

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* 29. Upload Application Packet as described in the announcement as a single PDF

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