Va Form 10-1313-11 - Scientific Merit Review Board Summary Statement

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REHABILITATION RESEARCH AND DEVELOPMENT SERVICE
SCIENTIFIC MERIT REVIEW BOARD SUMMARY STATEMENT
1. HEALTH CARE FACILITY/NO.
2. LOCATION OF HEALTH CARE FACILITY
3. PRINCIPAL INVESTIGATOR(S), DEGREE
4. SOCIAL SECURITY NUMBER
5. VA TITLE
6. MERIT REVIEW DATE
7. PROJECT NUMBER/TITLE
8. AMOUNT REQUESTED EACH YEAR (PROGRAM
)
1ST
2ND
3RD
TOTAL
9A. VA SALARY SOURCE (Mark only one)
9. VA EMPLOYMENT STATUS (Mark only one)
10. TYPE OF PROJECT (Mark only one)
FULL -TIME
REHAB R&D
NEW
PART -TIME
CAREER DEVELOPMENT
ONGOING
WOC
PATIENT CARE
PILOT
OTHER
OTHER
11. NO. OF REHAB R&D PROJECTS
12. PRIMARY RESEARCH PRIORITY AREA
13. DEPARTMENT, LABORATORY, ETC. IN WHICH APPOINTMENT IS HELD
14. NAME OF ACADEMIC AFFILIATION AND TITLE OF MAJOR FACULTY APPOINTMENT
MONTH
YEAR
YEAR
TOTAL
PROJECT INITIATED
PROJECT TERMINATED
(CURRENT)
QUARTER FUNDING INITIATED
MERIT REVIEW BOARD RECOMMENDATION
1ST
DURATION (YEARS)
2ND
PRIORITY SCORES
3RD
SCIENTIFIC
PROGRAMMATIC
Page 11 of VA Form 10-1313 package
VA FORM
10-1313-11
OCT 1987

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