Name of Primary Applicant: ENTER PRIMARY APPLICANT NAME HERE

Centre for Innovation

Kenneth J. Fyke Award

2014 Application Form

Overview

Please review the Canadian Blood Services’ Kenneth J. Fyke Award Guidelines to ensure alignment of your application with the program objectives and eligibility criteria.

The application package (documents 1and 2) must be delivered by e-mail tocheryl.hubert@bloodand must be received by midnight October 1, 2014.

ApplicationPackage

Document 1: Application Form: A single PDF file which includes the completed application form: Sections 1 to 5, in singlespaced, Times New Roman or Arial (minimum size 11) font, 1 inch margins.

Document 2: CV: A single PDF file including a full Canadian Common CV ( in the CIHR format(Academic CV Type) for allProject Investigators. See section 2 for details.

Please direct questions about theCanadian Blood Services Kenneth J. Fyke Award Program, including the application process, .

Project Overview

Project Title (max 80 characters) - Be brief, capture the essence of what is to be done/found.

Primary Applicant - Identify one Investigator who will be responsible for managing the project, including allocation of project budgets, and progress reporting to Canadian Blood Services.

Last Name: / First Name:
Institution/Organization: / Position:
Address:
Telephone: / Email:

Proposed Project Start Date- Provide a proposed start date on or within three months of April 1, 2015 (yyyy/mm/dd):

ExecutiveSummary -Provide a summary (300 words max.) in lay terms of the proposal highlighting project objectives and deliverables, and describing how the research is aligned withthe Kenneth J. Fyke Award’s objective, including identified priorities, if applicable. If the project is approved, this summary may be published on Canadian Blood Services’ website.

ProjectTeam

Team members:In table below,list all proposed Project Investigators and Project Collaborators (note:Project Investigators are Canadian PI (principal investigators) who are requesting Canadian Blood Services funding, Project Collaborators are PI who are not requesting funding but who will be collaborating on the project). Do not include trainees and personnel.

CV:In a separate Document 2, provide a Canadian Common CV ( in the CIHR format (Academic CV Type) for allProject Investigators (the Primary Applicant and all other Principal Investigators requesting Canadian Blood Services funding). Please do NOT include collaborators’ and trainees’ CV. Do NOT submit your CV online to the CIHR, instead, after validating your CV just print as a PDF file.

Project Investigators (Canadian PI requesting funds from Canadian Blood Services):

Name / Position & Institution / Email
1.
Role in project:
2.
Role in project:
3.
Role in project:

Please insert rows as required.

Project Collaborators (Principal Investigators not requesting funds from Canadian Blood Services):

Name / Position & Institution / Phone & Email
1.
Role in project:
2.
Role in project:
3.
Role in project:

Please insert rows as required.

ProjectProposal

In nine (9) pages maximum(including tables & figures):

(a)Describe the background, rationale, and objectives of the project including any relevant preliminary findings.

(b) Outline the proposed research methods and approach, clearly demonstrating the integration of project members’ expertise towards achieving the goals of the project.

(c) Describe the relevance of the proposal to the Kenneth J. Fyke Award’s objective and identified priorities, if applicable.

(d) Detail the key deliverables anticipated by the end of the funding period.

A list of selected references for the research proposal may be included in addition to the nine (9) pages limit.

ProjectBudget

Please provide a budget for the Primary Applicant and other Project Investigators, as applicable.

Project budget must not exceed $100,000 for one year. Salaries for primary applicants (senior researchers) are not eligible. Funds may be used for stipends for trainees, expendable materials and supplies, project team collaborative and networking activities (e.g., team meetings, conference calls), and knowledge dissemination activities (e.g., publication costs).

Total amount requested for project: $______

Budget For Primary Applicant
Budget Overview
$ Amount Requested
Salaries & Benefits
Post-doctoral Fellows
Graduate/Post-Graduate Students
Summer Students
Technical/Professional Assistants
Other
Equipment
Purchase or Rental
Other
Materials and Supplies
Services
Meeting costs
Other
TOTAL
Budget Details: Provide specifications/justification/comments to your budget (no page limit).
Budget For otherProject Investigator (as applicable)
Name of Project Investigator:
Budget Overview
$ Amount Requested
Salaries & Benefits
Post-doctoral Fellows
Graduate/Post-Graduate Students
Summer Students
Technical/Professional Assistants
Other
Equipment
Purchase or Rental
Other
Materials and Supplies
Services
Meeting costs
Other
TOTAL
Budget Details: Provide specifications/justification/comments to your budget (no page limit).

Please copy table for other Project Investigators, if necessary.

Acknowledgment and Authorizations

I, , acknowledge that the enclosed application for research funding from the Canadian Blood Services represents a study of which I am the Primary Applicant and was responsible for the development of the proposal. If funded I will act as the Primary Applicant and will assume primary responsibility for the implementation and performance of the proposed study.

______

SignatureDate

The undersigned agree that the general conditions governing the award of a grant apply to any grant made pursuant to this application and are hereby accepted by the applicant(s) and the institution(s).

Primary Applicant
Name / Signature / Date
Primary Applicant Institution’s Representative
Name / Signature / Date
Project Investigator
Name / Signature / Date
Project Investigator Institution’s Representative
Name / Signature / Date

Please copy table for other Project Investigators, if necessary.

Kenneth J. Fyke Award Program _ 2014 Application Form (Form KFA-01)Page 1 of 8