{"id":4692,"date":"2022-05-17T13:36:18","date_gmt":"2022-05-17T17:36:18","guid":{"rendered":"https:\/\/www.med.unc.edu\/corefacilities\/?page_id=4692"},"modified":"2022-05-17T13:36:18","modified_gmt":"2022-05-17T17:36:18","slug":"cfac-cost-sharing-and-matching-fund-request-submission-form","status":"publish","type":"page","link":"https:\/\/www.med.unc.edu\/corefacilities\/cfac-cost-sharing-and-matching-fund-request-submission-form\/","title":{"rendered":"CFAC Cost-Sharing and Matching Fund Request Submission Form"},"content":{"rendered":"<script type=\"text\/javascript\">\n\/* <![CDATA[ *\/\nvar gform;gform||(document.addEventListener(\"gform_main_scripts_loaded\",function(){gform.scriptsLoaded=!0}),document.addEventListener(\"gform\/theme\/scripts_loaded\",function(){gform.themeScriptsLoaded=!0}),window.addEventListener(\"DOMContentLoaded\",function(){gform.domLoaded=!0}),gform={domLoaded:!1,scriptsLoaded:!1,themeScriptsLoaded:!1,isFormEditor:()=>\"function\"==typeof InitializeEditor,callIfLoaded:function(o){return!(!gform.domLoaded||!gform.scriptsLoaded||!gform.themeScriptsLoaded&&!gform.isFormEditor()||(gform.isFormEditor()&&console.warn(\"The use of gform.initializeOnLoaded() is deprecated in the form editor context and will be removed in Gravity Forms 3.1.\"),o(),0))},initializeOnLoaded:function(o){gform.callIfLoaded(o)||(document.addEventListener(\"gform_main_scripts_loaded\",()=>{gform.scriptsLoaded=!0,gform.callIfLoaded(o)}),document.addEventListener(\"gform\/theme\/scripts_loaded\",()=>{gform.themeScriptsLoaded=!0,gform.callIfLoaded(o)}),window.addEventListener(\"DOMContentLoaded\",()=>{gform.domLoaded=!0,gform.callIfLoaded(o)}))},hooks:{action:{},filter:{}},addAction:function(o,r,e,t){gform.addHook(\"action\",o,r,e,t)},addFilter:function(o,r,e,t){gform.addHook(\"filter\",o,r,e,t)},doAction:function(o){gform.doHook(\"action\",o,arguments)},applyFilters:function(o){return gform.doHook(\"filter\",o,arguments)},removeAction:function(o,r){gform.removeHook(\"action\",o,r)},removeFilter:function(o,r,e){gform.removeHook(\"filter\",o,r,e)},addHook:function(o,r,e,t,n){null==gform.hooks[o][r]&&(gform.hooks[o][r]=[]);var d=gform.hooks[o][r];null==n&&(n=r+\"_\"+d.length),gform.hooks[o][r].push({tag:n,callable:e,priority:t=null==t?10:t})},doHook:function(r,o,e){var t;if(e=Array.prototype.slice.call(e,1),null!=gform.hooks[r][o]&&((o=gform.hooks[r][o]).sort(function(o,r){return o.priority-r.priority}),o.forEach(function(o){\"function\"!=typeof(t=o.callable)&&(t=window[t]),\"action\"==r?t.apply(null,e):e[0]=t.apply(null,e)})),\"filter\"==r)return e[0]},removeHook:function(o,r,t,n){var e;null!=gform.hooks[o][r]&&(e=(e=gform.hooks[o][r]).filter(function(o,r,e){return!!(null!=n&&n!=o.tag||null!=t&&t!=o.priority)}),gform.hooks[o][r]=e)}});\n\/* ]]> *\/\n<\/script>\n\n                <div class='gf_browser_unknown gform_wrapper gravity-theme gform-theme--no-framework' data-form-theme='gravity-theme' data-form-index='0' id='gform_wrapper_10' style='display:none'>\n                        <div class='gform_heading'>\n                            <h2 class=\"gform_title\">CFAC Cost-Sharing and Matching Funds Request Form<\/h2>\n                            <p class='gform_description'>CFAC Criteria for funding decisions:\r\n<br>\r\n1) Is the request strategic? Does it add new\/unique technology?\r\n<br>\r\n2) Is there a strong user base?\r\n<br>\r\n3) Is there a clear identification of additional matching funds sources for internal cost shares?\r\n<br>\r\n4) Is the core compliant (current planning survey and rates?)\r\n<br>\r\n5) Are letters of support specific and convincing?<\/p>\n\t\t\t\t\t\t\t<p class='gform_required_legend'>&quot;<span class=\"gfield_required gfield_required_asterisk\">*<\/span>&quot; indicates required fields<\/p>\n                        <\/div><form method='post' enctype='multipart\/form-data'  id='gform_10'  action='\/corefacilities\/wp-json\/wp\/v2\/pages\/4692\/' data-formid='10' novalidate>\n                        <div class='gform-body gform_body'><div id='gform_fields_10' class='gform_fields top_label form_sublabel_below description_above validation_below'><div id=\"field_10_21\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_10_21\" ><label class='gfield_label gform-field-label' for='input_10_21'>Requestor Name<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_21' id='input_10_21' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><fieldset id=\"field_10_20\" class=\"gfield gfield--type-email gfield--input-type-email gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_10_20\" ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Requestor Email<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_complex ginput_container ginput_container_email gform-grid-row' id='input_10_20_container'>\n                                <span id='input_10_20_1_container' class='ginput_left gform-grid-col gform-grid-col--size-auto'>\n                                    <input class='' type='email' name='input_20' id='input_10_20' value=''    aria-required=\"true\" aria-invalid=\"false\"  \/>\n                                    <label for='input_10_20' class='gform-field-label gform-field-label--type-sub '>Enter Email<\/label>\n                                <\/span>\n                                <span id='input_10_20_2_container' class='ginput_right gform-grid-col gform-grid-col--size-auto'>\n                                    <input class='' type='email' name='input_20_2' id='input_10_20_2' value=''    aria-required=\"true\" aria-invalid=\"false\"  \/>\n                                    <label for='input_10_20_2' class='gform-field-label gform-field-label--type-sub '>Confirm Email<\/label>\n                                <\/span>\n                                <div class='gf_clear gf_clear_complex'><\/div>\n                            <\/div><\/fieldset><div id=\"field_10_3\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_10_3\" ><label class='gfield_label gform-field-label' for='input_10_3'>Requestor Department<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_3' id='input_10_3' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_10_4\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_10_4\" ><label class='gfield_label gform-field-label' for='input_10_4'>Core Name<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_4' id='input_10_4' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><fieldset id=\"field_10_31\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full field_sublabel_below gfield--has-description field_description_above field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_10_31\" ><legend class='gfield_label gform-field-label' >Is your core an open recharge core?<\/legend><div class='gfield_description' id='gfield_description_10_31'>Are the core's rates set through an OSP-led rate review process?<\/div><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_10_31'>\n\t\t\t<div class='gchoice gchoice_10_31_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_31' type='radio' value='Yes'  id='choice_10_31_0' onchange='gformToggleRadioOther( this )' aria-describedby=\"gfield_description_10_31\"   \/>\n\t\t\t\t\t<label for='choice_10_31_0' id='label_10_31_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_10_31_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_31' type='radio' value='No'  id='choice_10_31_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_10_31_1' id='label_10_31_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_10_33\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_10_33\" ><legend class='gfield_label gform-field-label' >Is your core administered or affiliated with a center<\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_10_33'>\n\t\t\t<div class='gchoice gchoice_10_33_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_33' type='radio' value='Yes, administered by a center'  id='choice_10_33_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_10_33_0' id='label_10_33_0' class='gform-field-label gform-field-label--type-inline'>Yes, administered by a center<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_10_33_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_33' type='radio' value='Yes, affiliated with a center'  id='choice_10_33_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_10_33_1' id='label_10_33_1' class='gform-field-label gform-field-label--type-inline'>Yes, affiliated with a center<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_10_33_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_33' type='radio' value='No'  id='choice_10_33_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_10_33_2' id='label_10_33_2' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_10_34\" class=\"gfield gfield--type-textarea gfield--input-type-textarea gfield--width-full field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_10_34\" ><label class='gfield_label gform-field-label' for='input_10_34'>If the core is affiliated with a center, please describe which center(s), whether the core receives financial support (subsidy) from the center, and  whether center members receive discounted rates<\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_34' id='input_10_34' class='textarea large'      aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/div><div id=\"field_10_14\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_10_14\" ><h3 class=\"gsection_title\"><\/h3><\/div><fieldset id=\"field_10_26\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_10_26\" ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Please specify the mechanism for this request<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_10_26'><div class='gchoice gchoice_10_26_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_26.1' type='checkbox'  value='Matching funds for an external instrumentation grant submitted by the core director or the core&#039;s faculty advisor'  id='choice_10_26_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_10_26_1' id='label_10_26_1' class='gform-field-label gform-field-label--type-inline'>Matching funds for an external instrumentation grant submitted by the core director or the core's faculty advisor<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_10_26_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_26.2' type='checkbox'  value='Matching funds for a PI-led grant to purchase instrumentation and place it within the core'  id='choice_10_26_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_10_26_2' id='label_10_26_2' class='gform-field-label gform-field-label--type-inline'>Matching funds for a PI-led grant to purchase instrumentation and place it within the core<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_10_26_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_26.3' type='checkbox'  value='Internal Cost-Share'  id='choice_10_26_3'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_10_26_3' id='label_10_26_3' class='gform-field-label gform-field-label--type-inline'>Internal Cost-Share<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_10_5\" class=\"gfield gfield--type-textarea gfield--input-type-textarea gfield--width-full gfield_contains_required field_sublabel_below gfield--has-description field_description_above field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_10_5\" ><label class='gfield_label gform-field-label' for='input_10_5'>Please describe the full proposed equipment and how the matching funds will be used<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='gfield_description' id='gfield_description_10_5'>CFAC does not typically fund salaries for personnel through this mechanism. CFAC funds can support service contracts, serve as a back-stop for expenses related to this equipment, or provide a match to the cost of the instrument itself.<\/div><div class='ginput_container ginput_container_textarea'><textarea name='input_5' id='input_10_5' class='textarea large'  aria-describedby=\"gfield_description_10_5\"   aria-required=\"true\" aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/div><div id=\"field_10_10\" class=\"gfield gfield--type-textarea gfield--input-type-textarea gfield--width-full gfield_contains_required field_sublabel_below gfield--has-description field_description_above field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_10_10\" ><label class='gfield_label gform-field-label' for='input_10_10'>Justification of funds<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='gfield_description' id='gfield_description_10_10'>Please explain the existing and anticipated customer base for this instrumentation. If this equipment is duplicative of another core facility please explain why the duplication is necessary based on throughput. Please provide metrics. <\/div><div class='ginput_container ginput_container_textarea'><textarea name='input_10' id='input_10_10' class='textarea large'  aria-describedby=\"gfield_description_10_10\"   aria-required=\"true\" aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/div><div id=\"field_10_24\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full gfield_contains_required field_sublabel_below gfield--has-description field_description_above field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_10_24\" ><label class='gfield_label gform-field-label' for='input_10_24'>Submission deadline<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='gfield_description' id='gfield_description_10_24'>We will consider your request at the CFAC meeting following the next request deadline. For FY budget planning purposes, please indicate when you intend to submit your grant or purchase your equipment. <\/div><div class='ginput_container ginput_container_text'><input name='input_24' id='input_10_24' type='text' value='' class='large'  aria-describedby=\"gfield_description_10_24\"   aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_10_15\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_10_15\" ><h3 class=\"gsection_title\"><\/h3><\/div><div id=\"field_10_6\" class=\"gfield gfield--type-number gfield--input-type-number gfield_contains_required field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_10_6\" ><label class='gfield_label gform-field-label' for='input_10_6'>Approximate Total Cost of Instrumentation<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_number'><input name='input_6' id='input_10_6' type='number' step='any'   value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"  \/><\/div><\/div><div id=\"field_10_7\" class=\"gfield gfield--type-number gfield--input-type-number gfield--width-full gfield_contains_required field_sublabel_below gfield--has-description field_description_above field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_10_7\" ><label class='gfield_label gform-field-label' for='input_10_7'>Amount Requested from CFAC<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='gfield_description' id='gfield_description_10_7'>For matching funds for equipment grants, please submit to CFAC the total cost to fulfill the match. CFAC will reach out to recommend if additional fund sources are necessary. <\/div><div class='ginput_container ginput_container_number'><input name='input_7' id='input_10_7' type='number' step='any'   value='' class='large'     aria-required=\"true\" aria-invalid=\"false\" aria-describedby=\"gfield_description_10_7\" \/><\/div><\/div><fieldset id=\"field_10_28\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox gfield--width-full field_sublabel_below gfield--has-description field_description_above field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_10_28\" ><legend class='gfield_label gform-field-label gfield_label_before_complex' >For internal cost-shares please specify the anticipated contributors<\/legend><div class='gfield_description' id='gfield_description_10_28'>Please select all that apply<\/div><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_10_28'><div class='gchoice gchoice_10_28_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_28.1' type='checkbox'  value='Core&#039;s Depreciation\/External Sales Reserve Funds'  id='choice_10_28_1'   aria-describedby=\"gfield_description_10_28\"\/>\n\t\t\t\t\t\t\t\t<label for='choice_10_28_1' id='label_10_28_1' class='gform-field-label gform-field-label--type-inline'>Core's Depreciation\/External Sales Reserve Funds<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_10_28_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_28.2' type='checkbox'  value='Core&#039;s ADMINISTERING Department or Center'  id='choice_10_28_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_10_28_2' id='label_10_28_2' class='gform-field-label gform-field-label--type-inline'>Core's ADMINISTERING Department or Center<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_10_28_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_28.3' type='checkbox'  value='Core&#039;s AFFILIATED Center or Instiute'  id='choice_10_28_3'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_10_28_3' id='label_10_28_3' class='gform-field-label gform-field-label--type-inline'>Core's AFFILIATED Center or Instiute<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_10_28_4'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_28.4' type='checkbox'  value='School of Medicine Office of Research'  id='choice_10_28_4'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_10_28_4' id='label_10_28_4' class='gform-field-label gform-field-label--type-inline'>School of Medicine Office of Research<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_10_28_5'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_28.5' type='checkbox'  value='Office of the Vice Chancellor for Research'  id='choice_10_28_5'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_10_28_5' id='label_10_28_5' class='gform-field-label gform-field-label--type-inline'>Office of the Vice Chancellor for Research<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_10_28_6'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_28.6' type='checkbox'  value='PI&#039;s Department or Center (if different than Core)'  id='choice_10_28_6'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_10_28_6' id='label_10_28_6' class='gform-field-label gform-field-label--type-inline'>PI's Department or Center (if different than Core)<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_10_28_7'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_28.7' type='checkbox'  value='Departments or Centers of Major Users'  id='choice_10_28_7'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_10_28_7' id='label_10_28_7' class='gform-field-label gform-field-label--type-inline'>Departments or Centers of Major Users<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_10_9\" class=\"gfield gfield--type-textarea gfield--input-type-textarea gfield_contains_required 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