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2011Application for Young Investigator Award

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2011Application for Young Investigator Award Powered By Docstoc
					                                                                                   Principal Investigator

                            Voelcker Fund Young Investigator Award on Translational Science
                                                  Application Form


                               Send your complete application package (see page 2) to:
                      Emily Harrison Liljenwall, Max and Minnie Tomerlin Voelcker Fund,
                                 112 E. Pecan, 30th floor, San Antonio, TX 78205
                   Complete application packages must be received by March 2, 2009 4:00pm CST.

Project Title: (Maximum 75 characters)


Disease Area: (choose one or more areas from the Disease of interest to the Voelcker Fund i.e. cancer, heart disease,
arthritis, muscular dystrophy, retinitis and/or macular degeneration of the retina)


Clinical Research Type: (Check all that apply)
        Etiology/Pathogenesis          Therapeutic Intervention
        Disease Control                Epidemiology                                  Other


Principal Investigator: Full Name, Degree(s):
Current Appointment Title (e.g., Instructor, Assistant Professor):
Additional Current Job Title(s) (if any):
Institution:
Department:
Street Address:

City, State, Zip Code:
Telephone:                        Fax:                     E-mail:

Completion Date of Most Recent Fellowship:
First Faculty-level Appointment Title (e.g., Instructor or Assistant Professor):
First Faculty-level Appointment Date:                                       Institution:

All full-time post-fellowship Instructor-level positions will be considered full-time faculty-level appointments.

        Citizen of what country:

        Permanent resident of what country-documentation must be provided:


        Signature__________________________________________________ Date Submitted___________________


TENURE INFORMATION:
Does your institution offer tenure?
 If yes, are you on the tenure-track?
 If yes, do you have tenure?
                                                                                 Principal Investigator

GRANTS AND CONTRACTS OFFICIAL TO NOTIFY IF AWARDED:
Full Name:
Institution Name:
Title:
Department:
Street Address:

City, State, Zip Code:
Telephone:                       Fax:                     E-mail:

Initial to acknowledge that the investigator has a full-time faculty-level appointment at your institution.


Signature _____________________________________________________                    Date Submitted __________________


MENTOR INFORMATION:
Provide the following information for the mentor(s) who have submitted a letter of recommendation as part of this
application package. Do NOT include information on mentors who have not submitted a letter.

Mentor 1:
Full Name, Degree
Title(s):
Institution:
Department:

Mentor 2:
Full Name, Degree
Title(s):
Institution:
Department:

FORMATTING INSTRUCTIONS
  Font: Use 12-point font size throughout unless noted otherwise. Smaller font sizes are acceptable for use in tables and
  figure legends.
  Page Margins: Page margins should not be smaller than one inch on all sides, subject to preset format.
  Page Limits: Do not exceed the pages limits stated for each section.
  Appendices: Do not attach any additional materials except as allowed.

Proposals that do not meet the page limits (including letters) and formatting instructions will not be accepted.
Nominees not adhering to the instructions will not be notified or given a chance to revise their submission, so it is
very important to follow the instructions above.

A COMPLETE APPLICATION PACKAGE CONTAINS:
    1 signed original of the complete application;
    2 paper copies of the entire application; and
    1 CD-ROM containing a single Portable Document Format (PDF) file** containing the entire application.

**Applicants are strongly encouraged to review their final PDF file prior to submission. It is the applicant's responsibility
to ensure that all materials to be included in the application have been properly converted and inserted into the PDF file.

If you have questions, please read the Frequently Asked Questions at www.Voelckerfund.org. If your question is not
answered there, please send an email to eliljenwall@scs-law.com with "2009 Young Investigator" in the subject line.

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                                                                                                                       Principal Investigator

Table of Contents

Face Pages      ................................................................................................................................................................ 1-2
Table of Contents Page ....................................................................................................................................................... 3

Part 1: Proposal
Abstract (Maximum l/2 page) ............................................................................................................................................. 3
Acronym List (Maximum 1 page) ..............................................................................................................................
Biographical Sketch (Maximum 2 pages)
Provide three peer reviewed reprints either published or in press ..............................................................................
Career Goals and Objective (Maximum 1 page) .........................................................................................................
Research Plan (Maximum 9 pages including figures, excluding literature cited) .......................................................
Literature Cited ...........................................................................................................................................................
Budget Year l ...........................................................................................................................................................
Summary Budget and Budget Justification ..................................................................................................................
Description of Resources (Maximum l page) .............................................................................................................
Other Sources of Research Support ............................................................................................................................
Consultant/Collaborative/Contractual Arrangements (if applicable) ..........................................................................

Part II: Institutional Support Documents
Environmental and Institutional Commitment Letter (Maximum 2 page letter) ........................................................
Letter of Support from Mentor (Maximum 2 page letter) ........................................................................................ ...
Supporting Materials Template ....................................................................................................................................


Abstract (Maximum 1/2 page)
State the broad, long-term objectives and specific aims. Describe concisely the research design and methods for achieving
these goals. If the application is funded, this description may become public information.




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                                                                                   Principal Investigator

Acronym List (Maximum 1 page)
Provide a complete list of acronyms used in this proposal and their definitions.




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                                                                                                       Principal Investigator

Biographical Sketch (Maximum 2 pages; do not attach reprints. Use 10-point font.)

NAME:                                                                       POSITION TITLE:


__________________________________________________________________________________________________
EDUCATION/TRAINING (Begin with baccalaureate or other initial professional education, such as nursing, and include postdoctoral training.)
__________________________________________________________________________________________________
                     INSTITUTION AND LOCATION                       DEGREE           YEAR(s)                FIELD OF STUDY
                                                                 (if applicable)
_______________________________________________________________________________________________________________________________________




__________________________________________________________________________________________________


A.        Positions and Honors. List in chronological order previous positions, concluding with your present position.


          List any honors. Include present membership on any Federal Government public advisory committee.


B.        Peer-reviewed publications (in chronological order). Provide complete references to peer-reviewed
          publications only; highlight first author (or equivalent) publications. Do not include publications submitted or in
          preparation, abstracts, or case studies.


C.        Reprints. In addition, provide three peer reviewed reprints either in press or published (no manuscripts in
          preparation).




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                                                                               Principal Investigator

Career Goals and Objectives (Maximum 1 page)
Describe your career goals and objectives with particular emphasis on the relationship to clinical/translational research.
Indicate how your past scientific history relates to these goals and objectives. Indicate how a Voelcker Fund Young
Investigator Translational Development Award would facilitate achievement of your goals. If your interest in
clinical/translational research is a change in direction, please describe what prompted the change.




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                                                                              Principal Investigator

Research Plan (Maximum 9 pages including figures, excluding literature cited.)
The research plan must have the following sections:
    Hypotheses and Specific Aims. State the hypotheses that form the bases for the research and the specific aims
        that you intend to accomplish with the award.
    Background and Significance. Discuss the scientific knowledge that led to the stated hypotheses and specific
        aims and cite critical references. State the importance and health relevance of the proposed research.
    Preliminary Results. Present data pertinent to the proposed research, especially if they substantiate the validity
        of a new technique or hypothesis or demonstrate expertise in a new area of research.
    Research Design and Methods. Describe the procedures and methodology that will be used to accomplish the
        specific aims of the project. Discuss any potential difficulties and alternate approaches that might be taken to
        accomplish the goals.
    Time Frame. Provide estimated milestones for accomplishing key goals.




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                                                                                Principal Investigator

Literature Cited in Research (No page limit; use 10-point font.) Provide complete references to literature cited in the
body of the research plan.




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                                                                           Principal Investigator

BUDGET YEAR 1: The investigator must devote at least 50% effort to translational research throughout the duration of
the award. Although salary support is not required, the investigator and his/her percent effort must be listed.


Personnel (Name/Job Title)            %Effort         %Salary        Salary          Fringe          Subtotal
1.                                         %               %         $               $               $
2.                                         %               %         $               $               $
3.                                         %               %         $               $               $
4.                                         %               %         $               $               $
                                                                                     Year 1. Personnel Total: $
Consultants (Name/Job Title)
1.                                          %                %       $               $               $
2.                                          %                %       $               $               $
                                                                                   Year 1. Consultants Total: $
Equipment
1.                                          %                %       $               $              $
2.                                          %                %       $               $              $
3.                                          %                %       $               $              $
4.                                          %                %       $               $              $
                                                                                    Year 1. Equipment Total: $
Supplies
1.                                          %                %       $                $               $
2.                                          %                %       $                $               $
3.                                          %                %       $                $               $
4.                                          %                %       $                $               $
                                                                                       Year 1. Supplies Total: $
Patient Costs
1.                                          %                %       $              $                $
2.                                          %                %       $              $                $
3.                                          %                %       $              $                $
4.                                          %                %       $              $                $
                                                                                 Year 1. Patient Costs Total: $
Travel
1.                                          %                %       $                $                $
2.                                          %                %       $                $                $
3.                                          %                %       $                $                $
4.                                          %                %       $                $                $
                                                                                          Year 1. Travel Total: $
Other Expenses
1.                                          %                %       $               $              $
2.                                          %                %       $               $              $
3.                                          %                %       $               $              $
                                                                               Year 1. Other Expenses Total: $



                                                             TOTAL DIRECT COSTS:   $
                                                             TOTAL INDIRECT COSTS: $
                                                             TOTAL YEAR 1:         $




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                                                                               Principal Investigator

Summary Budget
In the table below, provide summary budget information about how the award will be spent. The total duration of the
award will not exceed 5 years. The budget for each year cannot exceed $150,000 in total costs. Indirect costs cannot
exceed 10%. Travel costs cannot exceed $3,000 per year.

Total Budget
                      Year 1           Year 2            Year 3            Year 4             Year 5        Total (10%)
Personnel

Consultants

Equipment

Supplies

Patient Costs

Travel

Other

Direct Costs
Indirect Costs
Total

Budget Justification Include a short explanation of any exceptions to the investigator's time spent on the grant, large or
unusual budget allocations and other expenses that may not be self-evident. Do not provide justification of the entire
budget. (Maximum 1/2 page)




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                                                                                  Principal Investigator

Description of Resources (Maximum 1 page)
Specify the general laboratory/office facilities at your disposal. Indicate the specialized equipment and facilities required
for your research and their availability. Describe facilities for patient studies if needed, such as hospital units or clinical
research centers.




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                                                                          Principal Investigator

Other Sources of Research Support
List ALL current and pending internal and external sources of funding for the principal investigator. The following
FORMAT must be followed. Be sure to fully explain any potential funding overlap.


Current or Pending Funding?
Project Name
Award Type and Number
Funding Agency/Institution
Principal Investigator
Your Role on the Project and Percent Effort
Annual Direct Costs
Total Award (Direct and Indirect)
Project Period (start and end dates)
Brief Project Description
Indicate if the project is related to the work proposed
Indicate the project’s relationship to the work proposed in
this application

Current or Pending Funding?
Project Name
Award Type and Number
Funding Agency/Institution
Principal Investigator
Your Role on the Project and Percent Effort
Annual Direct Costs
Total Award (Direct and Indirect)
Project Period (start and end dates)
Brief Project Description
Indicate if the project is related to the work proposed
Indicate the project’s relationship to the work proposed in
this application

Current or Pending Funding?
Project Name
Award Type and Number
Funding Agency/Institution
Principal Investigator
Your Role on the Project and Percent Effort
Annual Direct Costs
Total Award (Direct and Indirect)
Project Period (start and end dates)
Brief Project Description
Indicate if the project is related to the work proposed
Indicate the project’s relationship to the work proposed in
this application




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                                                                                 Principal Investigator

Consultant/Collaborative/Contractual Arrangements (Each letter maximum 1 page)
If applicable, include letters verifying any consulting, collaborative, or contractual arrangements necessary to conduct the
proposed research. On this page, indicate in a list format, the attached letters. Note: Do not use these letters as the
recommendations letters required in the following sections.




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                                                                               Principal Investigator

Environment and Institutional Commitment (Maximum 2 pages)
Replace this page with a letter signed by the department chairperson* that must outline the following:
    the commitment the institution has made to enable the applicant to conduct translational/clinical research,
       including any provision for formal training in clinical research;
    the intellectual environment within the department and related disciplinary areas that are directly relevant to the
       applicant's research interests;
    the department's support of mentoring by key senior faculty;
    the plans and commitments the department and institution have made to assist the applicant to accomplish his/her
       career goals;
    the space that the institution has committed or will commit to the individual; and
    the institution's commitment to allow the applicant to devote 50% of his/her time to clinical research.

*Applicants who are part of a Department of Medicine may have their division chairperson write this letter.




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                                                                                 Principal Investigator

Letter of Support from Mentor (Maximum 2 pages)
Replace this page with a letter of support from the applicant's research mentor. This letter should indicate his/her
willingness to serve as the applicant's mentor, and, in that capacity, to meet with the applicant at least twice a month. The
letter must be no more than two pages in length. Letters longer than two pages will not be accepted.




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                                                                                    Principal Investigator

                                                                             2009 Young Investigator Supporting Materials
Voelcker Fund                                                                      Template

                                               Principal Investigator Information


Full Name:
                  Last                                       First                    MI        Degrees

Institution:


                                                Institutional Commitment Letter


Name:

Title:

Institution:                                                 Department:


                                                 Letter of Support from Mentor


Mentor 1:

Title:

Institution:                                                 Department:


Mentor 2:

Title:

Institution:                                                 Department:



                                      Consultant/Collaborative/Contractual Arrangements


1. Name:                                                     Institution:

2. Name:                                                     Institution:

3. Name:                                                     Institution:

4. Name:                                                     Institution:
*If applicable.
Append letters; scan and/or convert to a single PDF for upload.

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