APPLICATION REQUIREMENTS FOR A RESEARCH FELLOWSHIP (October 2015)

(a) Number of copies

One paper copy and one electronic copy of the complete application are required, as follows:

i. One paper copy of the completed application form (with original signatures), plus the original copies of all required academic transcripts. Transcripts must be appended to the back of the application form. The entire paper copy of the application must be stapled in the upper, left-hand corner; do not clip individual sections of the application separately.

ii. One signed PDF copy of the complete application. IMPORTANT: Upload your PDF to Sharefile here: https://cysticfibrosis.sharefile.com/r-r4c577d3ad694d4ea. The PDF must be a single file containing all sections of the application form and all academic transcripts, appended pages, etc., in the correct order. Both sides of the transcript, front and back, must be copied in the PDF. Applicants must ensure that transcripts in the PDF are clear and legible. If needed, combine multiple PDF files into a single file. The PDF must also have bookmarks to each individual section in the application form (i.e. Sections A: General Information to I: Undertaking of Institution or to Section K: Research Facilities in Canada [if applicable] plus Academic Transcripts; create bookmark links to go to these specific sections of the application). The file must be labelled as follows:

Surname_given name_CFC initial or renewal fellowship 2015 (i.e. Doe_John_CFC initial fellowship 2015)

(b) Completion of application

Sections A-E of the application form must be completed by the applicant. Sections F-I must be completed by the proposed supervisor. Sections J-K should only be completed if the applicant is requesting an award which is tenable at an institution outside of Canada.

(c) Deadline for submissions

The deadline for receipt of the electronic PDF and hard copy of your application is Thursday, October 1, 2015. Completed applications and all supporting materials will be accepted only if hand-delivered to Cystic Fibrosis Canada’s office by 5:00 p.m. EDT on October 1st OR courier-marked on/before midnight on the deadline day of October 1st. Applications sent by courier must have guaranteed next-business day delivery. Incomplete and/or late applications will be returned to the applicant.

Applications with supporting documentation must be sent to: Joanna Valsamis, Program Director, Research Funding, Cystic Fibrosis Canada, 2323 Yonge Street, Suite 800, Toronto, ON, M4P 2C9, (416) 485-9149. The letters of recommendation/letters-of-support must be emailed directly to .

Cystic Fibrosis Canada will acknowledge receipt of an application, via email, to the applicant by October 22nd.

(d) Initial applications: supporting documentation

i.  Three letters of recommendation, one of which should be from your current or most recent supervisor, must be emailed directly to Joanna Valsamis () and must arrive by the deadline.

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ii. Transcripts of the applicant's complete academic record from the issuing institution(s) must be included with the original copy of the application form as well as in the PDF.

(e) Renewal applications: supporting documentation

i. A letter-of-support from the applicant's supervisor, describing the quality of the applicant's work to date and commenting on the suitability of continued support, must be emailed directly to Joanna Valsamis () and must arrive by the deadline.

*** Please note that transcripts and additional letters-of-recommendation are not required for renewal applications. ***

Please contact Joanna Valsamis, Program Director, Research Funding () at Cystic Fibrosis Canada’s office if you have any questions.

PLEASE REMOVE THESE TWO COVER PAGES PRIOR TO PRINTING AND SUBMITTING THE APPLICATION FORM WITH ORIGINAL SIGNATURES AND CREATING A PDF COPY.

07/2015

APPLICATION FOR A FELLOWSHIP Initial application Renewal application

Sections A-E must be completed by the applicant.

A. GENERAL INFORMATION

Name of applicant

(Title, Given Name, Middle Name, Surname)

Mailing address

Cystic Fibrosis Canada must be notified if the applicant's mailing address changes.

Telephone E-mail

Title of proposed research project

Proposed host institution

For initial applicants, name and address of three references whom you have asked to provide letters of recommendation. For renewal applicants, only one letter-of-support from your supervisor is required.

1.

2.

3.

Current supervisor’s name, host institution and department

Proposed supervisor’s name, host institution, department, full mailing address and email

______

FOR OFFICE USE ONLY / Hard copy
___/___/___ / Entered
___/___/___ / Entered
___/___/___ / Acknowledged
___/___/___
Electronic copy
___/___/___ / Reference #1 / Reference #2 / Reference #3

07/2015

APPLICATION FOR A FELLOWSHIP Page 2

B. EDUCATIONAL BACKGROUND

Degrees held or expected

Transcripts included in the PDF and original copies appended to back of this application form.

Degree Start date End date Discipline Institution Supervisor (if applicable)

(dd/mm/yyyy date format)

Years and months of post-PhD academic experience as of October 1, 2015*:

* Fellowship (initial) applicants who will have completed four or more years of training as of the October 1st application deadline, following their Ph.D. or M.D., are not eligible for Cystic Fibrosis Canada Fellowships. Cystic Fibrosis Canada does offer flexibility on calculating years of training given parental leave, medical leave or exceptional circumstances. Applicants must contact Cystic Fibrosis Canada in advance, and before applying, given those cases to confirm eligibility.

Postgraduate training

Please include all postgraduate training to date, including residency training and appointments held. M.D. applicants, who received their medical degree four or more years prior to the date of application, must provide details of any research training undertaken since receiving their degree. This description should not exceed one page, and should be inserted following this page.

Start date End date Institution Position Supervisor

(dd/mm/yyyy date format)

Distinctions/awards

Please include all undergraduate and graduate awards, specifying dates held or received. Noteworthy invited lectures may also be included.

Start date (mm/yyyy) End date (mm/yyyy)

APPLICATION FOR A FELLOWSHIP Page 3

B. EDUCATIONAL BACKGROUND (cont'd.)

Publications

Please provide a list, with full references, of all papers and abstracts. Additional pages may be used, and should be inserted following this page.

For renewal applications only, published reprints and manuscripts (accepted, in-press, submitted) can be appended and should be inserted following the list of publications (only required in the electronic PDF file, not required in the printed hard copy). For any manuscript listed as “submitted”, please provide formal proof of submission (i.e. documentation from the journal itself that the manuscript has been submitted and received).

APPLICATION FOR A FELLOWSHIP Page 4

C. CAREER GOALS

Provide a brief description of your career goals, and explain how a Cystic Fibrosis Canada Fellowship would help to advance these goals.

D. SUMMARY OF PROPOSED TRAINING

For initial applications, please append a text-only summary of the research training to be undertaken during the tenure of this award. This should describe the background, methods, and objectives of the work proposed, and its relevance to cystic fibrosis. A proposal is deemed to be relevant to cystic fibrosis and have an impact on CF patients if it is has a high probability of achieving Cystic Fibrosis Canada’s mission to cure or control CF, or improve the health and/or quality of life for people with CF. This summary, written by the applicant in consultation with the supervisor, may not exceed three pages in length (single-sided, single-spaced, 1-inch margins on all sides, in 12 point font size), and should be inserted following this page.

For renewal applications, please append a text-only summary, written by the applicant in consultation with the supervisor, of the research accomplished during the past two years of the award, and of the program proposed for the following year. This summary may not exceed three pages in length (single-sided, single-spaced, 1-inch margins on all sides, in 12 point font size), and should be inserted following this page.

Cystic Fibrosis Canada places a high priority on ensuring that funded research addresses the organization’s mission and our core principles of funding the best science that has the highest probability of making an impact for CF patients.

References must follow the 3-page summary. Please note that references are excluded from the 3-page limit.

A maximum two-page appendix of figures, tables, charts and diagrams that best support the application can be inserted following the list of references. PLEASE NOTE THAT APPENDIX PAGES IN EXCESS OF THE TWO-PAGE MAXIMUM WILL BE REMOVED FROM THE APPLICATION.

E. UNDERTAKING OF APPLICANT

The undersigned has written, in consultation with the supervisor, the summary of proposed training and hereby agrees that the conditions governing the award of a Fellowship, as detailed in Cystic Fibrosis Canada’s Grants & Awards Guide, apply to any grant awarded under this application, and that these conditions are accepted by the applicant.

Please note that M.D. applicants must be eligible for licensure, and must provide documentation from the provincial licensing authority verifying such eligibility.

Signature of applicant ______Date

THE APPLICATION FORM, WITH SECTIONS A-E COMPLETED, SHOULD BE FORWARDED TO THE PROPOSED SUPERVISOR FOR COMPLETION OF SECTIONS F-I.

APPLICATION FOR A FELLOWSHIP Page 5

Sections F-I must be completed by the proposed supervisor. Please note that supervisors must hold an academic appointment.

F. PROPOSED TRAINING PROGRAM

Name of proposed supervisor

Name of applicant

Title of applicant's research project

Training time allocation: Research % (including bench work, clinical research, course work, and literature reviews)

Clinical % (instruction in clinical techniques, patient care and other responsibilities of clinical residency-related course work - not to exceed 20%)

Please provide a brief description of the training program to be undertaken by the applicant.

APPLICATION FOR A FELLOWSHIP Page 6

G. PROPOSED SUPERVISOR

Section G must be completed OR the CV module from a Cystic Fibrosis Canada research grant application (Sections D and E) may be appended OR a current curriculum vitae, which includes sources of funding and the number of publications from the last five years, may be attached in place of Section G.

Name

Title, Given Name, Middle Initial, Surname

Place of birth

City, Province/State, Country

Education

Degree/s Date received Discipline Institution Supervisor (if applicable)

Research training (post-doctoral)

Dates Institution Department Supervisor

Academic positions held and hospital appointments

Dates Institution Department Position

Distinctions/awards

APPLICATION FOR A FELLOWSHIP Page 7

G. PROPOSED SUPERVISOR (cont'd.)

Supervisory experience

Please list the trainees that you have supervised/co-supervised (and are currently

supervising/co-supervising) within the last five (5) years.

Name Program type Dates Degree Year degree received

(from/to) (received/expected)

Additional pages may be added, and must be inserted following this page.

Publications

Please indicate number of publications, as follows: Total Past five years

Refereed papers, published

Refereed papers, accepted/in press

Refereed papers, submitted

Book chapters, published or in press

Abstracts

Patents held or pending, including software

Please provide full references for all publications from the past five years only, subdivided into the above categories and indicate those publications which cite Cystic Fibrosis Canada support. Additional pages may be added, and should be inserted following this page.

APPLICATION FOR A FELLOWSHIP Page 8

G. PROPOSED SUPERVISOR (cont'd.)

Sources of funding

Please list all sources of active support and/or funds applied for, and describe the degree of overlap with this application. If the proposed supervisor holds, or holds and has applied for, more than three grants, additional pages should be attached following this page.

GRANT # Currently held Applied for
Principal Investigator:
Co-Investigator(s):
Granting Agency:
Title of Project:
Hours per week:
Period of support:
Amount: $
% Overlap with current application:
GRANT # Currently held Applied for
Principal Investigator:
Co-Investigator(s):
Granting Agency:
Title of Project:
Hours per week:
Period of support:
Amount: $
% Overlap with current application:
GRANT # Currently held Applied for
Principal Investigator:
Co-Investigator(s):
Granting Agency:
Title of Project:
Hours per week:
Period of support:
Amount: $
% Overlap with current application:

APPLICATION FOR A FELLOWSHIP Page 9

H. UNDERTAKING OF SUPERVISOR

I have read, contributed to, and endorse the research training program proposed by the applicant. If an award is granted, I agree to accept the Fellow for research training in my laboratory, and certify that adequate resources will be available to cover the costs of the Fellow's research.

Proposed Supervisor
Name / Signature / Date

I. UNDERTAKING OF INSTITUTION

The undersigned hereby agree that the conditions governing the award of a Fellowship, as detailed in Cystic Fibrosis Canada’s Grants & Awards Guide, apply to any grant awarded under this application, and that these conditions are accepted by this institution.

Head of Department or Dean of Faculty
Name / Signature / Mailing Address / Date
Executive Authority of Host Institution (within which the research will be conducted and funds administered)
Name / Signature / Mailing Address / Date
FINANCIAL OFFICER
Title
Dr. Mr. Ms. / Given Name / Surname
Position
Institution / Street Address
City / Province / Postal Code
Telephone / Ext. / Fax / Email

THE APPLICATION FORM, WITH SECTIONS F-I COMPLETED, SHOULD BE RETURNED TO THE APPLICANT FOR SUBMISSION TO CYSTIC FIBROSIS CANADA.

APPLICATION FOR A FELLOWSHIP Page 10

Sections J-K should be completed only if the applicant is requesting an award which is tenable at an institution outside of Canada. The applicant should complete Section J, and have Section K completed by a Canadian scientist who is knowledgeable in the applicant's field of interest. Following the completion of Section K, the completed application form should be returned to the applicant for submission to Cystic Fibrosis Canada.

J. RATIONALE FOR REQUEST

Please outline your reasons for selecting a foreign laboratory.

Please defend the statement that training of a similar nature and calibre is not presently available in Canada.

K. RESEARCH FACILITIES IN CANADA

I have read this application for a Cystic Fibrosis Canada Fellowship tenable at an institution outside of Canada, and offer the following comments concerning opportunities in Canada for research training in the applicant's field of interest.

Signature ______

Date

Name

Position

Institution