YCSA Proposal 2007 by 6IrEI1

VIEWS: 3 PAGES: 9

									YCSA
Application 2007


                 FLIGHT ATTENDANT MEDICAL RESEARCH INSTITUTE
                       2007 YOUNG CLINICAL SCIENTIST AWARD
                                         Application Form
     All applications must be accompanied by an Individual Tobacco Disclosure Form from each
 investigator named on the proposal, and an Institutional Tobacco Disclosure form. These forms may
                       be downloaded from the FAMRI web site www.famri.org                                   Field Code Changed

 Please submit your application with the signed signature page as a pdf file to famri@aibs.org. Please       Field Code Changed
   submit your completed, signed tobacco disclosure forms as a separate pdf file to famri@aibs.org           Field Code Changed


Investigator Information
Name (Last, First, MI) and degree:             Faculty___      Fellow____
Job Title:
Contact Information:
       Institution:
       Street Address:
       City, State, Zip
       Telephone:                                              Fax:
       E-mail:
Project Title:
Project area: (Check One)
Chronic sinusitis__ Cilia Abnormalities__ Chronic Bronchitis__ COPD/Emphysema__
Asthmatic/Allergy __ Heart/Cardiovascular Diseases___ Alzheimer’s Disease__Complications
in Pregnancy__ Endocrine diseases__ Infertility__ Inflammatory Diseases (Arthritis)__Chrohn’s
Disease__Cervical Cancer__ Bladder Cancer __Breast Cancer__ Ovarian Cancer__Head and
Neck Cancer__ Lung Cancer__ Other __ (please specify) __ __ __
Clinical Research Type: (Check all that apply)
Epidemiology__ Clinical Trial __ Etiology/Pathogenesis__ Therapeutic Intervention__ Disease
Control__ Health Outcomes__ Other __ (please specify) __ __ __
Is this proposal a resubmission? Yes____ No____
Animal and human subject information:
Animals to be used: Number____Species____
If the research in this proposal involves animals (only experiments using mice or rats will be
considered unless the animals are not to be sacrificed as a result of the research) please indicate
the date of Association for Assessment of Laboratory Animal Care approval:________
Human Subjects: Number____
If the research in this proposal involves human subjects please indicate the date of Institutional
Review Board approval:_______
PI signature:_______________________________________________________




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Application 2007


Institutional Official to notify if awarded:
Name (Last, First, MI):


Title:

Institution:


Address:




Telephone:
Fax:
E-mail:


Signature:_______________________________________________________________
Signature of the Appropriate Official Signifying Institutional Commitment:
________________________________________________________________________




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Application 2007

                                      Table of Contents

(Please number the pages of your proposal and insert page numbers in this Table of Contents)

Face Pages (Application form)

Table of Contents Page

Technical Abstract

Layman’s Abstract

Budget and Budget Justification

Other Sources of Research Support

List of Acronyms

Research Plan (Maximum twelve pages)

Literature Cited (no page limit)

Career Goals and Objectives (Max. 1 pages)

Training in Clinical and Laboratory Research (Max. 1 pages)

Environment and Institutional Commitment (Max. 2 pages)

Resources

Biographical Sketch of the PI (Max. four pages)

Biographical Sketches of all other investigators named in the proposal (Max. two pages)

Consultants/Collaborative/Contractual Agreements

Three Letters of Reference

For resubmissions only: Response to previous review: (Max. five pages)




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YCSA
Application 2007

                                      Technical Abstract
State the broad, long-term objectives and specific aims, making reference to their relatedness to
early detection, treatment, and cure of diseases and medical conditions associated with exposure
to second hand tobacco smoke. Describe concisely the research design and methods for
achieving these goals. If the application is funded, this description may become public
information. Use a font size no smaller than 12-point.
[Enter your 400 word (or less) abstract here]




                                      Layman’s Abstract
Please provide a brief summary written for the general public describing the project's
objectives, proposed methodology, anticipated results, and practical significance. Please
emphasize how your proposal relates to diseases cause by second hand tobacco smoke. If
the application is funded, this abstract may be used in FAMRI publications. Please limit the
abstract to two paragraphs. Use a font size no smaller than 12-point.




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YCSA
Application 2007



                   FAMRI YOUNG CLINICAL SCIENTIST AWARD 2007

                                            Faculty
                               Budget and Budget Justification
                      (Use this form if you have a faculty appointment)

For Faculty applications: Provide general budget information about how the $100,000 per year
award will be spent. Note that no more than 8.5% ($8,500) per year may be spent on indirect
costs. Justify major budget items on a second page.

Total Budget
% Effort Salary/ Fringe Benefits/ Year 1/ Year 2/ Year 3/ Personnel




Consultants

Equipment

Supplies

Travel

Patient Costs

Other

Indirect Costs (8.5%)$8,500          Total $108,500




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YCSA
Application 2007

                    FAMRI YOUNG CLINICAL SCIENTIST AWARD
                                          Fellow
                            Budget and Budget Justification
                       (Use this form if you are a research fellow)

For Clinical Research Fellowship applications: Provide general budget information about how
the $75,000 per year award will be spent. Up to $50,000 can be used for salary and stipend
support, and the remainder for fringe benefits, research support, and travel. Justify major
budget items on a second page.

Total Budget
% Effort Salary/ Fringe Benefits/ Year 1/ Year 2/ Personnel




Equipment

Supplies

Travel

Other

Indirect Costs (8.5%)$6,375          Total $81,375




-




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YCSA
Application 2007

Other Sources of Research Support

Please list all current or pending internal and external sources of funding whose funding period
overlaps with the YCSA. Each listing should include:
        Project Name
        Funding Agency/Institution
        Principal Investigator
        Your role on the Project and Percent Effort
        Yearly Support ($)
        Project Period (start and end dates)
        Brief Project Description
        Indicate if the project is related to the work proposed (Yes/No)
        If “Yes”, indicate the project’s relationship to the work proposed in this application

List of Acronyms (please include a list of all acronyms used in the proposal)

Research Plan (Maximum 12 pages)
The research plan should be divided into the following six sections:

      Hypothesis and specific aims – indicate the hypothesis that forms the basis for the research and specific
      aims that you intend to accomplish with this award.

      Background and significance – discuss the scientific knowledge that led to the stated hypothesis
      and specific aims, why this project is novel, the importance of the proposed research and its potential
      relevance if successful.

      Preliminary results – it is not expected that the applicant will have preliminary results included in the
      proposal, but if results are available they should be described.

      Research design and methods – briefly describe the procedures and methodology that will be used to
      accomplish the study aims, and discuss how potential pitfalls might be avoided.

      Time frame – provide an estimated time for accomplishing key goals. If the proposed work is likely to take
      longer than two years, indicate the total time frame and overall scope of the project and what you hope to
      accomplish in the three years.

Literature cited (No page limit).

Career Goals and Objectives (Maximum 1 page)
Describe your career goals and objectives with particular emphasis on the relationship to
research proposed in this application. Indicate how your past scientific history relates to these
goals and objectives and how receiving this award would facilitate achievement of your goals. If
your interest in research is a change in direction, please describe what prompted the change.
Please comment on your commitment to clinical or translational research.
Training in Clinical and Laboratory Research (Maximum 1 page)
Please indicate what research training you have had or plan in the event the award is made. List any courses,



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Application 2007

indicate when they were taken, and provide a brief description of their content. In particular, FAMRI is interested in
course work on study design, clinical trial, biostatistics, bioethics, and other topics that directly impact your ability
to conduct high-quality research.

Environment and Institutional Commitment (Maximum 2 pages)
The department chairperson or appropriate institutional official (and for research fellows, their research mentor),
should indicate what commitment the institution has made to enable the applicant to conduct clinical research,
including any provision for formal training in clinical research. The section should also include a discussion of the
intellectual environment within the department and related disciplinary areas that are directly relevant to the
applicant’s research interests and how the department supports mentoring by key senior faculty. Discuss what plans
and commitments the department and institution have made to assist the applicant to accomplish his/her career
goals. This should include a description of the space that the institution has committed or will commit to the
individual. In addition, a statement should be included indicating that if this proposal is awarded, the institution will
allow the applicant to devote at least 75% of his/her time to research. This statement must be written and
approved by the chairperson or the appropriate institutional official and signed by said individual on the
face page of this application.

Resources
Specify what general laboratory/office facilities are at your disposal to conduct your research.
Indicate what specialized equipment and facilities are required.

Biographical Sketches :
      Principal Investigator: (Maximum 4 pages) The biographical sketch should include the
      applicant’s name, position, and title. This should be followed by education/training
      information (earliest training and degree first) and research and professional experiences
      including the applicant’s current position. Please include complete references to all
      scientific, medical publications during the past four years as well as pertinent earlier
      publications.
      Co-investigators (maximum 2 pages) All Co-investigators named in the proposal
      should provide an NIH-style biosketch.

Consultant/Collaborative/Contractual Arrangements If needed, include electronic copies of
letters verifying any consulting, collaborative or contractual arrangements necessary for the
conduct of the research. It is not necessary to include resumes for these individuals.

Three Letters of Reference
These letters should be from scientists who have served as mentors or who are familiar with the
applicant's training and research experience. At least one letter should be from a senior scientist
in the institution who is serving as or has agreed to serve as the applicant's mentor. The letters
should discuss: (1) applicant’s potential and commitment to conducting clinical research; (2) the
adequacy of the applicant's scientific background and formal clinical research training, (3)
evidence of original thinking, and (4) the quality of past research and publications. In addition,
the letter from the mentor should comment on the appropriateness, quality, and importance of the
submitted proposal and on his or her role as mentor. The signed letters should be scanned and
submitted as part of your proposal (preferred). If you wish, you may send the originals to
FAMRI YCSA c/o AIBS 1900 Campus Commons Drive, suite 200, Reston VA 20191.



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YCSA
Application 2007



Re-submissions only: (maximum five pages) If this proposal is a re-submission you should
respond to the reviewers’ comments in this section.




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