Individual Fellowship Application Guide - UCLA School of Nursing

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PHS SF424 (R&R) Individual Fellowship Application GuideField NameOrganizational DUNSLegal NameDepartmentDivisionStreet1Street2CityCounty/ParishStateProvinceInstructionsEnter the DUNS or DUNS+4 number of the applicant organization. Thisfield is required.For submission to NIH and AHRQ, this DUNS must match thenumber entered in the eRA Commons Institutional Profile forthe applicant organization. The AOR is encouraged to confirmthat a DUNS has been entered in the eRA CommonsInstitutional Profile prior to submitting an application. If yourorganization does not already have a DUNS number, you willneed to go to the Dun & Bradstreet Web site athttp://fedgov.dnb.com/webform to obtain the number.Enter the legal name of the applicant which will undertake the assistanceactivity, enter the complete address of the applicant (includingcounty/parish and country), and name, telephone number, e-mail, andfax of the person to contact on matters related to this application.Enter the name of the primary organizational department, service,laboratory, or equivalent level within the organization that will undertakethe assistance activity.Enter the name of the primary organizational division, office, or majorsubdivision which will undertake the assistance activity.Enter the first line of the street address for the applicant in “Street1”field. This field is required.Enter the second line of the street address for the applicant in “Street2”field. This field is optional.Enter the city for address of applicant. This field is required.Enter the county or parish for address of applicant.Enter the State where the applicant is located. This field is required if theapplicant is located in the United States.Enter the Province.If “Country” is not Canada, please leave blank.CountryZIP CodeSelect the country for the applicant address. This field is required.Enter the nine-digit Postal Code (e.g., ZIP code) of applicant. This fieldis required if the applicant is located in the United States. This field isrequired if a State is selected; optional for Province.Part I: Instructions for Preparing and Submitting an Application I-42
PHS SF424 (R&R) Individual Fellowship Application GuidePerson to be contacted on matters involving this application:This information is for the Administrative or Business Official, not the Fellowship applicant. Thisperson is the individual to be notified if additional information is needed and/or if an award ismade. To avoid potential errors and delays in processing, please ensure that the informationprovided in this section is identical to the AO profile information contained in the eRACommons.Field NamePrefixFirst NameMiddle NameLast NameSuffixPhone NumberFax NumberEmailInstructionsEnter the prefix (e.g., Mr., Mrs., Rev.) for the person to contact onmatters related to this application.See also the PHS Fellowship Supplemental Form for additionalrequired contact information.Enter the first (given) name of the person to contact on matters related tothis application. This field is required.Enter the middle name of the person to contact on matters related to thisapplication.Enter the last (family) name of the person to contact on matters related tothis application. This field is required.Enter the suffix (e.g., Jr., Sr., Ph.D.) for the person to contact on mattersrelated to this application.Enter the daytime phone number for the person to contact on mattersrelated to this application. This field is required.Enter the fax number for the person to contact on matters related to thisapplication.Enter the email address for the person to contact on matters related tothis application.Provide only one email address. This is a required field forapplications submitted to NIH and AHRQ.6. Employer IdentificationEnter either TIN or EIN as assigned by the Internal Revenue Service. If your organization is not in theUS, enter 44-4444444. This field is required.If you have a 12-digit EIN established for grant awards from NIH or other PHS agencies, enterall 12digits (e.g., 1123456789A1).7. Type of ApplicantThis information is for the Applicant Organization, not a specific individual AOR or PD/PI.Part I: Instructions for Preparing and Submitting an Application I-43
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