KuhnResearchAward-ApplicationFormOct2208 by peirongw

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									Form-Research Kuhn # ____

The Jay Kuhn Memorial Hodgkin Research Award Juravinski Cancer Centre Foundation

This award, named in memory of Jay Kuhn, is designed to provide funding support for Hodgkin Disease or non Hodgkin Lymphoma Research at the Juravinski Cancer Centre.

Scope of the Awards Program: The Program will provide an annual award in support of Hodgkin Disease or non Hodgkin Lymphoma research initiatives undertaken by staff employed within the Oncology Program at Hamilton Health Sciences and/or be a member of the Department of Oncology at McMaster University. 1.0 Process to Apply 1.1 Applications for The Jay Kuhn Memorial Hodgkin Research Award will be received by the JCC Foundation – Grants & Distribution Committee by April 1st each year (**PLEASE NOTE – for the 2008 year, applications are due November 14th). 1.2 A completed Juravinski Cancer Centre Foundation Research Application Form will be submitted to the JCC Foundation. 2.0 Process for Payment 2.1 An ad hoc committee will be formed including representation from JCC Administration, Department of Oncology, the JCC Foundation and at least two Oncology Program Staff . The Grants & Distribution Committee shall review all completed grant applications and determine awards to be disbursed subject to final approval by the JCC Foundation Board. 2.2 The funding for approved research will be transferred through the JCC Finance Department as required.

Created 03/2008

Form-Research Kuhn # ____

The Jay Kuhn Memorial Hodgkin Research Award Juravinski Cancer Centre Foundation Research Application Form
The Juravinski Cancer Centre Foundation (JCCF) was established to raise money to support capital projects, purchase medical and research equipment to conduct cancer related research, support provider and public education and cancer patient care. Projects must be compatible with the Juravinski Cancer Program’s (JCP) mission, strategic plan and management priorities.    Each grant will be awarded for a one year term only. Requests for multi-year grants will not be accepted. A separate application will need to be submitted each year. Grants will be awarded to a maximum of $10,000 for Hodgkin Disease or non Hodgkin Lymphoma research The principal investigator must work at and conduct their cancer research at Hamilton Health Sciences and/or be a member of the Department of Oncology at McMaster University

A complete application must include: 1. A clear summary of the proposed research that clearly states the case for support. 2. A budget, with supporting documentation. 3. A signature from the Chair of the Department of Oncology and Director of Cancer Research, Hamilton Health Sciences 4. A timeline for completion of the project. Applications that do not include these items will not be considered. The Grants and Distribution Committee will review all applications submitted by April 1st (for the 2008 year, applications are due November 14th) for grants to be made in June (for 2008 in December) of each year. All completed applications must include 4 full copies plus 8 copies of a 1 page “Project Information” summary (*see pg. 3) and be submitted to the Foundation Office. Section 1

Project Title

Amount requested

Principal Investigator Name and Signature

Supervisor Name and Signature (if submitted by PhD student) Telephone Extension

Location

Signature of Head, Cancer Research, Hamilton Health Sciences and Chair Department of Oncology

Date

Created 03/2008

Form-Research Kuhn # ____

Project Title:

Principal Investigator:

Name

Degree

Academic Title (if appropriate)

Oncology Program Area

Address Co-investigators:

Postal Code

Name

Degree

Academic Title (if appropriate)

Oncology Program Area

Address

Signature of Co-investigator

Name

Degree

Academic Title (if appropriate)

Oncology Program Area

Address

Signature of Co-investigator

Name

Degree

Academic Title (if appropriate)

Oncology Program Area

Address

Signature of Co-investigator

Name

Degree

Academic Title (if appropriate) Address

Oncology Program Area Signature of Co-investigator

Created 03/2008

Form-Research Kuhn # ____ Project Title __________________________________________________________________________ Principal Investigator ___________________________________________________________________ Duration of Proposed Research ___________________________________________________________ Expected Start Date ______________________ mm/dd/yy Funding Requested: (please list amounts)

Total Personnel Expendable Supplies Services Equipment

Research Category: (basic, translational, clinical trials, health services)

Indicate if Proposal Involves: Human experimentation: Animal experimentation: Biohazards: Include documentation indicating appropriate guidelines will be observed and that appropriate JCC and hospital (if applicable) bodies have approved application. *Project Information Summary: (maximum 1 page suitable for lay individuals) Scientific Abstract: (maximum of 250 words summarizing research proposal) Research Proposal: (maximum of 5 single spaced pages) Proposal Must Include: 1. Objectives 2. Background 3. Rationale 4. Methods (should include a clear description of sample and sample size, setting, methods for data collection and data analysis, and any ethical issues). 5. Significance (References are not included in 5 page limit). *Appendices may be attached at the discretion of the applicant. Budget Detail and Justification: Please submit a complete itemized budget with rationale. Abbreviated Curriculum Vitae: (maximum of 3 pages plus publications from last 3 years per investigator)

Created 03/2008

Form-Research Kuhn # ____ Project Title: Principal Investigator: Other Funding: Indicate all other active grants including amounts received, grants currently pending review including amounts requested, and percent of overlap with current proposal.

Accountability: The Principal Investigator is required to abide by the Foundation “Terms of Funding Agreement”(Sample attached) if proposal receives funding. The Principal Investigator is required to submit an interim report to the Foundation prior to receiving their final grant installment. The Principal Investigator is required to submit a final report to the Foundation within 6 months of completion of the project.

FOR FOUNDATION USE ONLY – NOT TO BE COMPLETED BY APPLICANT
Approval/Recommendation of Grants and Distribution Committee

Signature of Chairman

Date

Approval/Recommendation by the JCCF Board

Signature of Chairman

Date

Created 03/2008

Kuhn # ____

JCC Foundation Grants & Distribution Terms of Funding Agreement In order to receive funding, please note the following: 1. Upon receipt of this signed document, the Foundation will advise JCC Finance office to activate an account in your name, specifically for this grant. 2. The Foundation will transfer the first quarterly installment of your grant (25%) to JCC Finance. 3. The Foundation will transfer two subsequent installments of 25% each over the next 2 quarters to JCC Finance. 4. The final installment will be transferred into your account after the Foundation receives, in writing, an interim project report including: - How the funds have been used to date - Expected date of completion Important Note: Failure to submit an interim project report will result in delay or refusal of your final installment. 5. A final report must be submitted to the Foundation Office within 6 months of the completion of the research project including: - A breakdown of how the funds were used (final financial report) - A summary of publications referencing the research project - An abstract of research outcomes Important Note: Failure to submit a final report will affect future grant application consideration by the Foundation. 6. Funds not accessed within 12 months will be returned to the Foundation by JCC Finance and recipient must re-apply for funding approval. 7. These funds are encumbered for this specific project and any funds, which are not used, must be reimbursed back to the Foundation Office. 8. Any publications resulting from this project must acknowledge the support of the Juravinski Cancer Centre Foundation.

________________________________
Expected Start Date - (mm/dd/yy)

________________________________
Expected Date of Completion - (mm/dd/yy)

________________________________
Signature of Principal Investigator

________________________________
Date (mm/dd/yy)

________________________________
Signature of Chair, Grants & Distribution Committee

________________________________
Date (mm/dd/yy)

_________________________________
Signature of HHS Foundation President

________________________________
Date (mm/dd/yy)

Created 03/2008


								
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