APPLICATION REQUIREMENTS FOR EARLY CAREER INVESTIGATOR AWARD(October 2015)

(1)Number of copies

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

i.A signed PDF copy of the completed application must be submitted via Sharefile (see link below) no later than October 1st, 2015. The PDF must be a single file containing all sections of the application form and all appended pages, reprints, manuscripts, etc., in the correct order. A table-of-contents must be included and the PDF must also have bookmarks to each individual section in the application form (i.e. Section A: General Information to Section R: Undertakings of Applicant and Institution) plus appended pages, reprints, manuscripts, etc. The PDF must be labelled as follows: Surname_given name_CFC early career investigator award2015(e.g. Smith_John_CFC early career investigator award2015).

IMPORTANT: Upload your PDF here:

ii.One hard copy of the completed application form (with original signatures), plus any documents being submitted in support of the application (NEW: publications and manuscripts do not need to be printed as they will be on the electronic file; all other supporting documents and sections of the application form must be printed), must be forwarded to Joanna Valsamis at 2323 Yonge Street, Suite 800, Toronto, Ontario, M4p 2c9, (416) 485-9149 x230. The entire paper copy of the application must be bound with one appropriate-sized clip in the upper, left-hand corner or with elastic bands if necessary; do not clip individual sections of the application separately.

Please include a table-of-contents in both the paper copy and PDF to help guide reviewers through the application.

(2)Insertion of additional pages

All inserted additional pages must be 8.5” x 11”, single-sided, single-spaced, with 1-inch margins on all sides, in 12 point font size. Condensed type or spacing is NOT acceptable.

Sections B (Co-investigators/Collaborators), D (AcademicBackground), E (Sources of Funding), H (Detailed Research Project/Program), and J (Budget Rationale) allow applicants to attach additional pages. For the convenience of the reviewers, additional pages should be inserted in the appropriate section of the application form.

This does not apply to letters-of-recommendation, academic transcripts or reprints and manuscripts. These items should be appended to the back of the completed application form.

(3)Deadline for submissions

The deadline for receipt of the electronic PDF AND hard copy of your application is Thursday, October 1st, 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 1stOR courier-marked on/before midnight on the deadline day of October 1st. Applications sent by courier must have guaranteed next-day delivery. Incomplete and/or late applications will be returned to the applicant.The only documentation that will be accepted after the deadline is the certification required for animal, human, human embryonic stem cell, and/or biohazardous experimentation, and publication updates (editor’s notification/proof-of-acceptance only; manuscripts will not be accepted after the deadline date).

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Applications 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 x 230.

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

(4)Supporting documentation

i.Reprints and manuscripts: please see (1) above.

ii.Letters–of-recommendation must be included with the original copy of the application form as well as in the PDF. Letters-of-recommendation should provide support in regards to the applicant’s: education/training background, research aptitude, commitment, career goals and objectives, and potential as an independent researcher.

iii.The most recent academic transcripts must be included with the original copy of the application form as well as in the PDF. Scanned copies/reports are acceptable – we do not require official transcripts.

iv.Applicants must submit the budget and summary pages relating to grants held or applied for from other granting agencies.

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 EARLY CAREER INVESTIGATOR AWARD

Sections A-K and Q-R must be completed by the applicant.

A. GENERAL INFORMATION

EARLY CAREER INVESTIGATOR
Title
Dr.Mr.Ms.Prof. / First Name / Middle Name / Last Name
Position
MAILING ADDRESS
Institution / Department or Faculty
Street Address / Suite or Floor (if applicable)
City / Province / Postal Code / Email
Office Telephone
Ext. / Lab Telephone
Ext.
TITLE OF PROJECT OR PROGRAM
HOST INSTITUTION
BUDGET INFORMATION
Year One / Year Two
Amount requested / $ / $
Total amount requested / $
TIME COMMITMENT
Indicate the number of hours per week that the applicant, and where applicable, any co-investigator will be devoting to this project:
FINANCIAL OFFICER
Title
Dr.Mr.Ms. / First Name / Last Name / Position
Institution / Street Address
City / Province / Postal Code
Telephone / Ext. / Email
FOR OFFICE USE ONLY / Hard copy
___/___/___ / Entered
___/___/___ / Entered
___/___/___ / Acknowledged
___/___/___
Electronic copy
___/___/___ / External #1 / External #2 / External #3

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B. CO-INVESTIGATORS AND COLLABORATORS (if applicable*)

CO-Investigator & COLLABORATOR INFORMATION
Title
Dr.Mr.Ms.Prof. / First Name / Middle Name / Last Name
Institution / Department or Faculty
Street Address / Suite or Floor (if applicable)
City / Province / Postal Code
Check status: Co-Investigator Collaborator
Title
Dr.Mr.Ms.Prof. / First Name / Middle Name / Last Name
Institution / Department or Faculty
Street Address / Suite or Floor (if applicable)
City / Province / Postal Code
Check status: Co-Investigator Collaborator
Title
Dr.Mr.Ms.Prof. / First Name / Middle Name / Last Name
Institution / Department or Faculty
Street Address / Suite or Floor (if applicable)
City / Province / Postal Code
Check status: Co-Investigator Collaborator
Title
Dr.Mr.Ms.Prof. / First Name / Middle Name / Last Name
Institution / Department or Faculty
Street Address / Suite or Floor (if applicable)
City / Province / Postal Code
Check status: Co-Investigator Collaborator

*If you are proposing a program with multiple projects this section is not required. Please append additional copies of Page 2 if there are more than four Co-Investigators and/or Collaborators.

For each named Co-Investigator and Collaborator, please appenda one-page letter to the back of the application form detailing/explaining the interactions between the Principal Investigator and the Co-Investigator or Collaborator.

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C. REFERENCES

Name, address and e-mail of the three references you have asked to provide letters of support.

REFERENCE #1
Name / Institution / Department
Street Address / Suite or Floor (if applicable)
City / Province / Postal Code / Email
Telephone / Fax
REFERENCE #2
Name / Institution / Department
Street Address / Suite or Floor (if applicable)
City / Province / Postal Code / Email
Telephone / Fax
REFERENCE #3
Name / Institution / Department
Street Address / Suite or Floor (if applicable)
City / Province / Postal Code / Email
Telephone / Fax

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D. ACADEMIC BACKGROUND OF APPLICANT

The applicantmust complete a copy of this academic background form. A current curriculum vitae, which includes the number of publications from the last five years, may be attached in place of Section D.

Degrees held Transcripts included in the PDF appended to back of this application form (scanned copies/reports are acceptable).

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

Research training (post-doctoral, including residency training and appointments held).

Dates / Institution / Department / Supervisor (if applicable)

Distinctions/awards

Please include all studentships, fellowships, and similar awards, specifying dates held. Noteworthy invited lectures may also be included.

Distinction/award / Institution / Dates held

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D. ACADEMIC BACKGROUND OF APPLICANT (cont’d)

Publications

Please indicate number of publications, as follows:TotalPast 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 that cite Cystic Fibrosis Canada support. Additional pages may be added, and should be inserted following this page.

* Please provide formal proof of submission (i.e. documentation from the journal itself that the manuscript has been submitted and received). Proof of submission should be inserted following this page.

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E. SOURCES OF FUNDING

Please list all sources of active support and/or funds applied for, and describe the degree of overlap with this application. Support to the Principal Investigator and Co-Investigators must be included.

In addition, please provide a copy of the formal budget page and project summary/abstract pages of each grant currently held or applied for. These documents should be inserted following this page. DO NOT submit budget justification pages or budget rationale pages.

If additional pages are required, this page should be photocopied.

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

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F. SUMMARY OF RESEARCH TO DATE

Please describe the research in which you have been engaged, prior to and since receiving your doctorate or M.D. degree, and since your first academic appointment, and the results obtained. Indicate the date, institution, and supervisor where appropriate, and, in the case of collaborative research, outline your personal contribution. No additional pages may be added.

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G. SUMMARY OF PROPOSED RESEARCH PROGRAM

Applicants must provide, in the space below, a 200-word summary of their research program in non-scientific, everyday language at a level no greater than Grade 10[1]. It is critical that the summary be in lay language as it will be reviewed and evaluated, by two non-scientific stakeholders on the peer review panel and may be used to communicate to the public and donors about the research supported by Cystic Fibrosis Canada. 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. The lay summary must state how the proposed research is directly relevant to CF and what the impact of the proposed research is for CF patients.

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H. DETAILED RESEARCH PROGRAM

Please provide a clear and concise description of the proposed research program including: (a) background, general approach and hypothesis; (b) significant results obtained to date to support this program; (c) specific goals of the proposed program; (d) relationship of your program with other CF-related research programs in your institution and collaboration between your program and other investigators from your, or other, institutions; and (e) an impact statement detailing the potential importance of the proposed research to cystic fibrosis[2], and anticipated results. Excluding bibliography, appendices that contain relevant data presented in charts, figures, diagrams, gene maps, etc., and references, this proposal may not exceed 5 pages(single-sided, single-spaced, 1-inch margins on all sides, in 12 point font size). PLEASE NOTE THAT PAGES IN EXCESS OF THE MAXIMUM WILL BE REMOVED FROM THE APPLICATION AND NOT READ.

If using the Word version of the application form, you should delete the instructions above by using your delete or backspace key to make full use of the space in this section. If using the PDF version, you may append the 5 pages after this page.

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I. BUDGET

Please provide the following details on funds requested for Year 1.

Expense Category / Number / % of Time / Amount Requested
Personnel
Research assistants
Technicians
Other (please specify):
Fringe benefits
Materials & Supplies
Expendables
Animals
Services
Other (please specify):
Equipment
Total not to exceed $10,000, once per term grant
Travel
Maximum amounts are as follows: $1,565 (Ontario/Quebec); $1,905 (AB,MB/SK); $2,313 (PEI/NS/NB); $1,450 (BC); $2,720 (NL)
BUDGET SUMMARY PER YEAR / Total requested for Year 1 / $
Total requested for Year 2* / $
TOTAL REQUESTED, Years 1-2 / $

* Do not include any inflationary increases (COLA) in calculating amount requested.

As per Cystic Fibrosis Canada’s policy on Indirect Costs, Cystic Fibrosis Canada-funded research and clinic grants do not provide support for institutional overheads and/or indirect costs of research or clinical care.

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J. BUDGET RATIONALE

Please provide a rationale for each item appearing in the proposed budget on page 10 of the application. One additional page may be used and should be appended following this page.

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K. CANDIDATE’S STATEMENT

The candidate’s statement should:(1) provide an overview of their involvement in CF research;(2) outline their specific area(s) of research interest; (3) outline their future plans for research and overall career development; and (4) includetheir reasons for applying for a Cystic Fibrosis Canada Early Career Investigator Award.

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Sections L-P and R must be completed by the nominating institution.

L. NOMINATING INSTITUTION

Name of institution

Name of sponsors (Research Director/Chair of Department)

(Dean of Faculty)

Department in which the candidate holds an appointment

Title/rank of appointment

One of the sponsors from the nominating institution must provide a written letter:

i)Guaranteeing a minimum of 0.50FTE (full-time equivalent) protected research time for individuals with a health professional degree at a doctoral level (e.g. M.D.) who hold a licence to practice in a province or territory in Canada, or a minimum of 0.75 FTE protected research time for individuals with a Ph.D. degree or health professional degree at a doctoral level who do not hold a licence to practice in a province or territory in Canada (the remaining 0.25 or0.50 FTE may be devoted to teaching and/or clinical activities).

ii)Detailing the appointment including teaching load, clinical and administrative duties, lab/office space, resources (equipment or staff), start-up funds, etc.

M. RESEARCH INTERACTIONS

Please describe the opportunities that would be available to the applicant in terms of interaction with other researchers and research programs within the institution, and how these might serve to further the applicant's research goals and career development.

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N. RESEARCH FACILITIES

Please provide a brief description of (a) the amount and location of laboratory space; (b) the specialized equipment; (c) the shared facilities;and (d) start-up funds that will be available to the applicant.

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O. OTHER RESPONSIBILITIES

Please describe the nature and extent (hours per week) of non-research activities in which the applicant would be engaged, as follows. A maximum of 25% (PhDs) or 50% (MDs) may be devoted to these non-research activities (see Section L (i) for further details).

Teaching (including supervision of graduate students)

Administrative duties

Clinical work (if applicable)

P. CONTINUED SUPPORT

The nominating institution should provide a commitment that the institution intends to continue to support the Early Career Investigator following completion of the term of the award.

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Q. ADDITIONAL DOCUMENTATION AND UNDERTAKINGS

Please indicate whether the proposed research involves biohazardous materials and/or human and/or animal and/or human embryonic stem cell experimentation. All necessary approval forms must be received by February 1, 2016.

Biohazardous materialsYesNo

(If yes, is certificate: included with the application to follow)

Human experimentationYesNo

(If yes, is certificate: included with the application to follow)

Animal experimentationYesNo

(If yes, is certificate: included with the application to f ollow)

Human embryonic stem cell experimentationYesNo

(If yes, is certificate: included with the application to follow)

All applicants whose research involves animal experimentation must sign below to signify their agreement to conform with the principles enunciated by the Canadian Council on Animal Care:

Signature of applicant______

R. UNDERTAKINGS OF APPLICANT AND NOMINATING INSTITUTION

The undersigned hereby agree that the conditions governing the award of an Early Career Investigator Award, as detailed in the 2015/2016Cystic Fibrosis Canada Grants & Awards Guide, apply to any grant awarded under this application, and that these conditions are accepted by the applicant's institution.These conditions include the terms of Cystic Fibrosis Canada's policy on patents and royalties, which are as follows:

A.In this policy “Invention” refers to new and useful tools, technology, processes or objects arising out of research funded in whole or in part by Cystic Fibrosis Canada, for example, diagnostic tools, proteins and genes, drugs, and methods of treatment.

B.The Institution and the Principal Investigator shall within 10 days provide Cystic Fibrosis Canada with a copy of any Invention disclosure statement or record of like effect prepared by one or both of them, and with a copy of all patent applications and patents pertaining to Inventions made by one or both of them. In the event that none of the foregoing documents has been prepared, the Principal Investigator shall provide Cystic Fibrosis Canada with a statement of the results of research funded in whole or in part by Cystic Fibrosis Canada upon conclusion of such research.