Application Form

FIOCRUZ – PASTEUR – USP Call 2017

1)Project title:
2)Coordinator at Fiocruz:
Name:
Phone:
E-mail:
Link CVLattes (Brazilian):
Laboratory:
Laboratory Head (name and e-mail):
3)Coordinator atInstitut Pasteur International Network:
Department / Unity / Institute:
Name:
Phone:
E-mail:
Laboratory:
Laboratory Head (name and e-mail):
4)Coordinator at University of São Paulo:
Department / Unity / Institute:
Name:
Phone:
E-mail:
Laboratory:
Laboratory Head (name and e-mail):
5)Project dates (beginning / end):October 2017 – December 2018
6)Key words:
7)Summary: (describe in 2 pages maximum : thematic, objectives, international context, experimental approach, expected results and the contribution of each partner to aggregate knowledge)

8)Other participants / Team

Name / Unity / Institute / Function / e-mail / Phone
9)Full description of the research project (max. 8 pages):
This presentation must include:
-Specific objectives of the study
-State of the art and bibliographical references: Specify how your study will refine, revise, or extend what is now known according to the regional objectives and needs considering the international competition scenario
-Project Plan (experimental approach, population studied, sample size)
-Expected results and schedule of the project
-Prospective in term of future programs/regional actions
-MainEvaluation Area
Alternative Evaluation Area 1
Alternative Evaluation Area 2
-Main publications on the subject of each participating group

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10)Schedule

From…………..……. to ……………..

Objectives / Oct 2017 – Dec 2017 / Jan 2018 – Dec 2018
AIM 1 / AIM 2 / AIM 3 / AIM 4 / AIM 1 / AIM2 / AIM 3 / AIM 4
Team 1
Team 2
Team 3

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11)Budget prevision:

The total budget planned for the 15 months must be equal at Fiocruz, at USP and at Institut Pasteur (IPIN). The maximum total budget for 15 months may attain 90 k€ (being 30 k€ / institution)

Budget planned at Fiocruz for 15 months (max 30 k€) / Amount
Amount for missions / Plane tickets to IPIN or to USP
Per-diem for reception of IPIN or USP researchersin Fiocruz
Amount for consumables / Consumables
Total
Budget planned at Institut Pasteur (IPIN) for 15 months (max 30 k€) / Amount
Amount for missions / Plane tickets to Brazil
Local costs for reception of Fiocruz or USP researchers in IPIN
Amount for consumables / Consumables
Total
Budget planned at USP for 15 months (max 30 k€) / Amount
Amount for missions / Plane tickets to IPIN or to Fiocruz
Per-diem for reception of IPIN or Fiocruz researchers in USP
Amount for consumables / Consumables
Total

12) Evaluation

Please identify the researchers who may have conflict of interest to evaluate the proposal

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