CLL Global Research Foundation Application Checklist
(Do not include with application.) All administrative signatures have been completed Scientific abstract is provided. Budget and justification provided. Certification page completed. Human Investigation, Laboratory Animals and Biohazard Statements included in appendix, where applicable. Milestones and expected completion dates provided. Research Plan (not to exceed 6 pages.) References can be included with the research plan but do not count toward the page limit. No required font or font size. Specific margins are not required. Biographical sketch (using standard NIH format) for all key personnel are provided. For each individual, the biosketch does not exceed four pages. A detailed list of other research support, both current and pending, is provided in the biographical sketches.) The biographical sketch appears after the research plan and before the appendix. Appendix and list of attachments is included. The completed application should be emailed to Diane Lee (firstname.lastname@example.org) by 5:00 p.m. (CST) on Friday, August 17, 2007. The cover page, with original signature, should be postmarked no later than August 17, 2007 and mailed to: Diane Lee CLL Global Research Foundation For regular mail: Unit 428 P.O. Box 301402 Houston, TX 77230-1402 For courier mail: 1400 Holcombe Blvd., 4th floor FC4.3024 Houston, TX 77030 If you have any questions, please contact Diane Lee at (713) 792-0758.
CLL Global Research Foundation Application Cover Sheet
Project Title: Investigator Last Name: Institution: Funding requested (no more than $100,000, in increments of $1,000): $ Does the grant involve human subjects or specimens? Yes No If yes, exemption number or IRB approval date: Assurance compliance number: Does the grant involve vertebrate animals? Yes No Research Administrator: Last Name: Title: Telephone: Fiscal Officer: Last Name: Title: Telephone: If yes, IACUC approval date: or Animal Welfare Assurance number: First Name: E-mail: Fax: First Name: Degree:
First Name: E-mail: Fax:
Declaration: The undersigned reviewed this application and are familiar with the policies, terms and conditions pertaining to this grant. We accept the obligation to comply with all such policies, terms and conditions. If applicant is selected, we authorize publication of the lay abstract prior to entering into any formal agreement. Applicant: Name: Signature: Date: Department Chair: Name: Signature: Date: Authorized Institution Officer: Signature: Date: Name:
CLL Global Research Foundation Scientific Abstract page 2
Scientific Abstract: Abstract should be limited to 300 words and should address in some detail the working hypothesis or question to be addressed, the scientific rationale and experimental design. (The abstract should be identical to that submitted with the letter of intent).
CLL Global Research Foundation Budget page 3
Category Personnel Expenses (name, project role) Amount requested Percent effort % % % % %
Subtotal Personnel Expenses Equipment (itemize)
$ $ $ $ $ $ $
Supplies and Materials (Itemize By Category) $
Travel Expenses $ Other Direct Expenses (Itemize by Category)
$ Total Direct Costs Indirect Costs (maximum of 5%) Total Costs (Direct + Indirect) $ $ $ Should not exceed $100,000, total should be in increments of $1,000.
CLL Global Research Foundation Budget Justification page 4
Provide Justification for each item in the budget listed on page 3. The budget justification should provide a clear and concise explanation for all cost items.
CLL Global Research Foundation Certification page 5
Human Materials or Subjects (Please check one.)
The proposed project has received approval from the IRB or ethics committee for research on primary CLL specimens or human subjects. The appendix includes a copy of the IRB approval letter. Approval from the IRB or ethics committee is pending. (Date of Protocol Submission: ). Project will be submitted for IRB or ethics committee approval. Planned date of protocol submission is . The proposed project does not involve the use of human materials or subjects.
Laboratory Animals (Please check one.)
The proposed project involves the use of laboratory animals and has received approval from the IACUC. The appendix includes a copy of the IACUC approval letter containing the date and assurance number). The proposed project involves the use of laboratory animals and IACUC approval is pending. The proposed project does not involve the use of laboratory animals.
Biohazards (Please check one.)
The proposed project involves the use of biohazards and an institutional statement of assurances regarding potential biohazards and safeguards is attached in the appendix. The proposed project does not involve the use of biohazards.
CLL Global Research Foundation Milestones page 6
For each proposal, there should be a minimum of three major milestones along with expected completion dates (up to 2 years.)
Milestone (brief description)
* 1st year ^ 1-2 years
CLL Global Research Foundation Research Impact page 7
Research Impact: Please check the primary research priority that the proposal addresses (only one). If other priorities are addressed, you may explain in the description below. The priority should be the same as the one previously selected on the Letter of Intent. Proteomics and other post-genomic technologies applied to the investigation of CLL Molecular definition and characterization of prognostic factors, relevant to the natural history of CLL Drug development; Molecular targets in CLL; Identification of and interruption of CLL survival pathways New vaccine and gene therapy approaches New monoclonal antibodies that target CLL cells or restore immune functions Etiology of CLL: a) molecular genetics b) extrinsic factors Methods for quantifying residual disease in CLL Cell/Stroma interaction Other (if your proposal does not address one of the aforementioned priorities.) Please describe how the proposed research will fit into above stated research priorities of the CLLGRF. (No more than 100 words.)
CLL Global Research Foundation Research Plan page 8
The proposal should include aims of the study, background, preliminary data, a statement of significance to individuals with CLL, methods and protocol/study design. (Attach additional pages as necessary; research plan not to exceed six pages.)