Foundation for Celiac Disease

/ APPLICATION FORM
FC Fellowships - Call for Proposals 2017

- FC -

Fondazione Celiachia

APPLICATION FORM

FC FELLOWSHIPS

CALL FOR PROPOSALS 2017

Legend

Legend / Definition
Applicant/Candidate / The Applicant or Candidate is the young graduate and/or post-doctoral fellow who aims at receiving the FC triennial fellowship and submit the research plan
FC Fellow / The Applicant awarded with the FC Fellowship Grant
Triennial FC Fellowship / The FC Fellowship is the triennial employment contract between the Hosting Institute and the awarded Applicant.
Each Triennial FC Fellowship is granted by FC for an overall amount of € 85.000, of which € 75.000 for the triennial gross salary of the FC Fellow (€ 25.000 per year gross salary) and € 10.000 to be used during the Triennial FC Fellowship program exclusively for the purchase of Consumables and Supplies.
Head of the Hosting Lab
[HHL] / The Head of the Hosting Lab is the senior investigator coordinating the laboratory in which the awarded Applicant will perform the research plan
Hosting Institute
[HI] / The Hosting Institute is the public or private non-profit Italian research institute in which the Head of the Hosting Lab is working, and the awarded Applicant will perform the research plan
The Legal Representative of the Hosting Institute
[LR] / The Legal Representative is the authorised representative of the Hosting Institute, who will be responsible, along with the Head of the Hosting Lab, of all the legal and administrative duties related to the FC fellowship award.
The Legal Representative of the Hosting Institute signs the Application Signature Page Form and the annexed Head of the Hosting Lab Letter Signature Form, thus guaranteeing that the Fellowship and the research plan will be performed in the Hosting Institute under the conditions established within the Call and the annexed Regolamento FC per i Bandi Fellowship.

Notes

In case of check boxes, for selecting click twice on the appropriate grey box and choose ‘SELEZIONATO’ on the pop up message

Section 1 –Applicant’s Data

All the fields are mandatory

Surname
Name
Gender / F M
Birth date
(dd/mm/yyyy) /
Tax Code
(codice fiscale)

Is the Applicant receiving any kind of active FC Grant as principal investigator, internal collaborator, fellow, doctorate, technician,etc., nor as multicentre study partners receiving part of the funds of the active FC Grant?

YES NO

Graduation Information

Type of University Degree obtained / Master’s Degree
[equivalent to the Italian Laurea Magistrale]
Long Single Cycle Degree
[equivalent to an Italian Laurea a ciclo lungo, lasting 5 or 6 years]
Non-Italian degree equivalent to the Master’s Degree or to the Long Single Cycle Degree
Bachelor’s degree
[equivalent to the Italian Laurea Breve]
University Degree – date of award(dd/mm/yyyy) /
Obtained at
(COMPLETE name and location/address of the University)
Discipline
(i.e. Medicine, Biology, Chemistry etc.)

Doctorate Information (if any)

Doctorate [if any] – date of award (dd/mm/yyyy) /
Obtained at
(COMPLETE name and location/address of the University)
Discipline
(i.e. Medicine, Biology, Chemistry etc.)

Contact address and current status of the Applicant

Current Position # 1

Current organisation
(COMPLETE name and location/address)
Current Department/Faculty/ Institute/Laboratory
Landline phone
Email
Current Head of the Laboratory
Current Positionof the Applicant
(status of the Applicant within the current organization: i.e. Fellow etc.) / Starting date (dd/mm/yyyy):
Deadline date (dd/mm/yyyy):
Description:
The Applicant is receiving a continuous employment income for this position:
YES NO
These data are declared under the responsibility of the Applicant. FC reserves the right to verify this information at any moment.

Current Position # 2 (do not complete if not occurring)

Please, reproduce the above table – by copying and pasting it IN the present Section of the Application Form - as many times as the number of current positions held by the Applicant at any site/centre/institute, or even in the same institution

Section 2–Data of the Hosting Institute in which the Fellowship and the Research Plan will be carried out

Please, provide below all the data relating to the Hosting Institute which will host the Applicant under the responsibility of the Head of Laboratory, and those relating to the Legal Representative of the HI.

All the fields are mandatory

Hosting Institute details

Legal name
Short name [if available]
Address of the organisation (Street)
City
Zip code
Tax Code of the HI
(codice fiscale/P.IVA)
The HI is a non-profit research organization?
(see definition under Section 5 of the FC Call 2017) / YES NO
This declaration is made under the responsibility of the Applicant

Legal Representative details

Surname
Name
Phone
email
Tax Code (codice fiscale)
ONLY in case the Director of a Department within the Hosting Institution is duly authorised to sign as Legal Representative of the Department, check the box / flag this box
By flagging this check box you aredeclaring that the Director of the Department is duly authorised to sign on behalf of the LegalRepresentative of the Institution.
This declaration is made under the responsibility of the Director of the Departmentand of the Applicant

Section 3 –Data of the Head of the Hosting Lab working at the Hosting Institute in which the Fellowship and the Research Plan will be carried out

All the fields are mandatory

Title
(i.e. doctor, professor, …)
Surname
Name
Gender / FM
Tax Code
(codice fiscale)
Affiliation / Institute and COMPLETE Address (including Street, Zip Code and City):
Department:
Laboratory:
Landline Phone
Email

Is the Head of the Hosting Lab receiving any kind of active FC Grant as principal investigator, internal collaborator, fellow, doctorate, technician, etc., nor as multicentre study partners receiving part of the funds of the active FC Grant?

YES NO

Is any other member of the research group of theHead of the Hosting Lab submitting any Proposal to this same FC Call?

YES NO

If YES, please indicate the name of the Applicant:

Section 4 –Keywords describing the Fellowship Project Proposal

Please, selectthe research topic andthe research areathat clearly define the key aspects of theFellowship research project

Research Topic Keywords

Please, select ONLY one research topic. Multiple choices will NOT be accepted

Celiac disease / Dermatitis herpetiformis

Research Area Keywords

Please, select ONLY one research area, the one on which the research project MAINLY focuses upon. Multiple choices will NOT be accepted.

Allergology / Anatomic pathology - Histopathology
Biochemistry / Biology (structural, computational, signalling)
Clinics (paediatrics or adult) / Clinical trials
Dermatology / Drug discovery – screening - development
Endocrinology / Epidemiology - Prevention
Genetics - Control of gene expression and epigenetics / Gynaecology
Immunology – Immunobiology / Infection and inflammation
Nutrition / Oncology
Preclinical study / Proteomics
Grains chemistry and biochemistry / Grain genomics and proteomics
Grain processing / Microbiology and grain biotechnology

Section 5 –Abstractof the FellowshipProject Proposal

Please, briefly describe the triennialFellowship project proposal. All boxes are mandatory. The total number of words (by summing up the boxes) must not exceed 500

Fellowship Project Proposal Title

Background

Hypothesis

Aims

Experimental design

Expected results and Impact on Celiac disease/Dermatitis Herpetiformis

Section 6–Description of the Fellowship Project Proposal

- Please, fully describe thetriennial Fellowship project proposalin detail by filling in accurately all the boxes and tables below, and by respecting the instructions provided.Figures can be embedded within boxes, provided that the dimension of the file remains small (see the Call – Section 7).

- All the information required in the boxes and tables below are mandatory, and incomplete information will lead to the Application’srejection.

Background

Please, describe in the box below the proposed research background. Relevant literature must be reported in the Box Bibliography.Not more than 150 words

Rationale and aims

Please, describe in the box below the research rationale and aims with special focus on impact on Celiac disease/Dermatitis Herpetiformis. Not more than 200 words

Experimental design and methodologies

Please, describe in the box below the experimental design and methodologies. If the methodology is new or unusual, please describe it in sufficient details for evaluation. The description of cumbersome experimental details and protocols, however, is not encouraged and generally detracts from the quality of the proposal. Not more than 250 words

Research plan

The research plan should be organised in tasks. Given existing difficulties in splitting clinical and epidemiological proposals into tasks, the task subdivision is mandatory for proposals in laboratory research areas only. Proponents of clinical and epidemiological studies should use subdivision in phases whenever possible, since this facilitates the work of reviewers and, in general, results in a better appreciation of the real value of the proposal. When the description of the research can be subdivided in tasks/phases, each numbered item must describe a precise part of the Fellowship project with its own experimental design and methodological approach. The objective (milestone) of each task/phase and the experimental design (including methods and time-frame) should be clearly identifiable and will be examined by the reviewers to evaluate the feasibility of the Fellowship project. Not more than 450 words

Potential pitfalls and caveats

Please, discuss here the potential difficulties and limitations of the procedures, and suggest any alternative approach to achieve the purposes. Not more than 100 words

Fellowship Project feasibility

Please, discuss here the project feasibility. If the case, also provide the following elements:

preliminary data – please provide enough preliminary data to support the working hypotheses, including figures

power calculation – for clinical and epidemiological studies, and whenever appropriate, make sure to have adequate sample sizes to ensure meaningful and statistically significant results

Not more than 150 words

Fellowship Project Innovation

Please, describe in the box below the novelty of the project with respect to either the methodologicaland/or conceptual approach. Not more than 100 words

Bibliography

Please, provide a list of all references employing the following format: S. Red, S. White, I.R. Black, M.L. Green. [title]. JPGN 2012; 54: 000–015. When available, please include a paper identification code (PubMedID or doi)

Any Other Relevant Information

Please, provide a brief description of any other relevant issue you consider as relevant for the understanding of the whole Fellowship research project. Not more than 100 words

Section 7 – Curriculum Vitae of the Applicant

Education and training

Please, list all degrees obtained (undergraduate, master’s and doctoral) and the corresponding scores/marks, following instructions in each box

Graduation Degree

Please report here the Final Score (Voto di Laurea) on 110 (best score):

Please report here the Discipline (Medicine, Chemistry, etc):

Please check one of the following boxes:

Thesis: Experimental Not Experimental

Title of the Thesis:

Briefly describe the Thesis (not more than 200 words):

Doctorate (if applicable)

Please report here the Final Score (if any) or evaluation of the examination committee (write N/A if not applicable):

Please report here the Discipline(Medicine, Chemistry, etc):

Please check one of the following boxes:

Thesis: Experimental Not Experimental

Title of the Thesis:

Briefly describe the Thesis (not more than 200 words):

Master or other Qualifications (if applicable)

Research and professional experience

Please, list all positions held after the attainment of thehighest degree (e.g. PhD) indicated in the previous section; use this section to list post-graduation or post-doctoraltrainings.

Also, indicate the name ofthe supervisor and describe very briefly (two-three sentences) the main focus of the research activitycarried out.Not more than 150 words

Skills

Please, list here technical skills, competences, clinical activity (if applicable), and underline their relevance to the success of the present Fellowship Project Proposal.Not more than 150 words

Courses and Awards

Please, list here Awards, participation to international meetings and courses.Not more than 100 words

Narrative biosketch

The Applicant is invited to explain how his/her education and early experience in aresearch lab have shaped his/her motivation and interest in pursuing a career in the research of Celiac disease/Dermatitis Herpetiformis. The Applicantshould also describe how he/she will benefit from working in the selected hosting lab and why itrepresents the most suitable place to for his/her personal and professional development.Not more than 250 words

Publications of the Applicant

Total Impact Factor (last five years)1
Active Impact Factor (last five years)2

1Total IF = the sum of IFs of articles published by the Applicant in the last five years (1 January 2012 – 15March 2017). The impact factor must be calculated according to the last current version of ISI Web of Knowledge

2Active IF = the sum of IFs of articles where the Applicant is first, last and/or corresponding author in the last five years(1 January 2012 – 15March 2017). The impact factor must be calculated according to the last current version of ISI Web of Knowledge

Published/Accepted Papers

- Please, provide in the table below the list of maximum 15 papers of the Applicant (published and/or accepted) in the last five years (from the 1 January 2012 – 15March 2017).

- Only publications being relevant to the research topic have to be mentioned, as this is considered relevant for peer reviewers for assessing the expertise of the Applicant in the specific research area

- Please, fill in all columns and list publications in reverse chronological order

Status[1] / First Author / Title / Journal, Year, Volume & Pages / Impact Factor of Journal[2] / Authorship role of the Applicant[3]
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.

Section 8 – Curriculum Vitae of the Head of the Hosting Lab

Education and Training

Please list in reverse chronological order degrees and post-doctoral trainingsof the Head of Hosting Lab (only the most relevant). For each entry, please complete all the columns displayed.

Add as many rows as needed

Degree/Training / Institution/University / Country and City / Field of Study/Research / Time Frame
(from - to)

Research and Professional Experience

Please list in reverse chronological order the most relevant positions held by the Head of Hosting Lab. For each entry, please complete all the columns displayed.

Add as many rows as needed

Position / Institute/University/Company / Country and City / Time Frame
(from - to)

Publications of the Head of the Hosting Lab

Total Impact Factor (last five years)1
Active Impact Factor (last five years)2

1Total IF = the sum of IFs of articles published by the Head of the Hosting Lab in the last five years (1 January 2012 – 15March 2017). The impact factor must be calculated according to the last current version of ISI Web of Knowledge

2Active IF = the sum of IFs of articles where the Head of the Hosting Lab is first, last and/or corresponding author in the last five years(1 January 2012 – 15March 2017). The impact factor must be calculated according to the last current version of ISI Web of Knowledge

Published/Accepted Papers

- Please, provide in the table below the list of maximum 15 papers of the Head of the Hosting Lab (published and/or accepted) in the last five years (from the 1 January 2012 – 15March 2017).

- Only publications being relevant to the research topic have to be mentioned, as this is considered relevant for peer reviewers for assessing the expertise of the Head of the Hosting Lab in the specific research area

- Please, fill in all columns and list publications in reverse chronological order

Status[4] / First Author / Title / Journal, Year, Volume & Pages / Impact Factor of Journal[5] / Authorship role of the Head of the Hosting Lab[6]
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.

Description of the Head of Hosting Laboratory’s expertise

Please, provide details on Head of Hosting Lab’s qualification, past experience and accomplishments that are directly relevant to the success of the present Fellowship Project Proposal

FC - Fondazione Celiachia –

Scientific Office

Via Caffaro 10, 16124 Genoa, Italy

/ APPLICATION FORM
FC Fellowships - Call for Proposals 2017

Section 9 – Estimated Research Budget Plan

In this Section the Applicant describes,in agreement with the Head of the Hosting Lab,how to allocate resources/research grants/fundsalready available to the Head of the Hosting Labin order to carry out the proposed Triennial FC Fellowship Research Plan described in Sections 4, 5 and 6 of this Application Form.

As reported in the FC Fellowships – Call for Proposals 2017 (Section 9 – Funding), each Triennial FC Fellowship is granted for an overall amount of € 85.000, of which€ 75.000 for the triennial gross salary of the FC Fellow (€ 25.000 per year gross salary) and € 10.000 to be used during the Triennial FC Fellowship Programmeexclusively for the purchase of Consumables and Supplies.

The funding of € 75,000 for the triennial gross salary of the FC Fellow is allocated as three € 25,000 instalmentsper year

The € 10,000 fundscan be allocated freely by the Applicant over the 3-years FC Fellowship Program. For instance, the Applicant might plan to allocate € 5,000 in the first year of the Triennial FC Fellowship Program, € 2,500 in the second year, and € 2,500 in the third year. The allocation plan of the € 10,000 funds is free and must be coherent with the Research Plan described in Sections 4, 5 and 6 of this Application Form. The € 10,000 funds can be used exclusively for purchasing Consumables and Supplies, in addition to resources already available to the Head of the Hosting Lab, and materials purchased with these funds must be accounted properly into theFinancial Annual Report (as described in the FC Fellowships – Call for Proposals 2017, Section 9 – Annual Instalments and Reports)