2018André Schroeder Research PrizeApplication Form

For a binding submission for the 2018 André Schroeder ResearchPrize, this application form is to be completed in full, signed and emailed to the ITI Headquartersto o later than September15, 2017.

First Applicant1:

First Name:
Last Name:
Title:
Nationality:
Address: / Street:
ZIP Code & City:
State & Country:
Phone:
Fax:
Email:

1The First Applicant must be the first author listed on the paper submitted.

Further Applicants2:

Name, title, nationality of further applicants:

2All co-authors who appear on the paper submitted must be listed.

This is an application for the:

Preclinical André Schroeder Research Prize
Clinical André Schroeder Research Prize
Title of the paper:
The paper has been accepted for publication in (mm/yy) and will be published in the following journal:
The paper was published in (mm/yy) in the following journal:
E-publication ahead of print in (mm/yy)
Print-publication in (mm/yy)

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Terms and Conditions of Participation

  1. Each year, the ITI awards a prize for preclinical research and one for clinical research, each endowed with CHF 10,000.
  1. The submission must represent an original research paper (hereinafter referred to as the “paper” or “papers”) in the area of implant dentistry, oral tissue regeneration and related fields. The research project may includepreclinical or clinical studies related to implant dentistry, oral tissue regeneration and related fields.
  1. The paper submitted must be original work. It must have been published within the 12 months prior to the application deadline or it must have been accepted for publication at the time of application. Unpublished papers that have not been accepted for publication will not be considered.
  2. The paper must be in English.
  3. The paper is to be submitted to the ITI Headquarters electronically (i.e. by email) in anonymized form together with a copy of the original paper (in the case of a published paper) or together with a copy of the manuscript acceptedfor publication listing all authors and with a proof of acceptance document (if the paper has not yet been published) and the completed and duly signed application form. The anonymized paper must bear no names or references that would indicate the identity of the authors. The paperas well as the completed and duly signed application form stating the Applicants’ names and First Applicant’s contact details(hereafter referred to as “Application Package”) are to be submitted to ITI Headquarters as PDFs via email to by September15, 2017.
    The André Schroeder Research Prizes are adjudicated by the ITI Research Committee.The Application Packages will be handled by ITI Headquarters and a code number will be assigned to each application.ITI Headquarters coordinates the evaluation process with the ITI Research Committee.

Checklist of items to be submitted in the case of a published paper:

1) completed and signed application form

2) copy of the published paper

3) published paper in anonymized form

Checklist of items to be submitted in the case of a paper that has not yet been published:

1) completed and signed application form

2) copy of the manuscript accepted for publication listing all authors

3) manuscript accepted for publication in anonymized form

4) proof of acceptance document issued by the publisher

  1. The First Applicant must be the first author listed on the paper submitted. All individuals listed on the paper as authors must sign the application form. By signing the application form, Applicants represent and warrant that they are the exclusive authorsof the paper submitted and also that no manipulation other than cropping, rotating and/or adjustments of contrast and brightness has been performed on the digital images presented with the paper.
  2. By signing the application form, the Applicants guarantee that all information given in connection with the application is true and valid and release theITIfromanyclaimsorlegalproceedingsbroughtbythirdpartiesarisingoutoftheinfringementofrights.
  3. The André Schroeder Research Prize and the associated prize money are not transferable. The latter is intended for the sole use of the named prize winner(s). Both individuals and groups may apply for the André Schroeder Research Prize. In the case of group applications, the names of those applying must be identical to those that appear in the research project publication (in the case of a published paper) or on the manuscript accepted for publication (if the paper has been accepted for publication but has not yet been published). Thefirst author must also be the First Applicant. In the case of prize award, the name of the First Applicant will be engraved on the medallion. The medallion will be handed over to the First Applicant. The prize money will be transferred to a bank account given to ITI Headquarters by the First Applicant. Should the First Applicant be unable to attend the award ceremony, he/she is to name a delegate to ITI Headquarters, who can attend the ceremony. This delegate must be a member of the team of authors listed on the winning paper.
  4. The First Applicant will be ITI Headquarters’ exclusive correspondence partner. ITI Headquarters will not enter into correspondence with any Applicants other than the First Applicant.
  5. The papers submitted will be evaluated by the ITI’s Research Committee according to their scientific relevance/relevance to current clinical issues in implant dentistry, oral tissue regeneration and related fields and content as well as their composition. If there are no submissions that are deemed worthy of the André Schroeder Research Prize, presentation of the Prize shall be deferred until the following year.
  1. The ITI Research Committee is composed of ten experts from various countries and disciplines. The names of the ITI Research Committee Members are published on the ITI website at
  1. The ITI Research Committee will evaluate all submitted papers that meet the requirements outlined in these terms and conditions of participation in anonymized form and will communicate their choice to ITI Headquarters. The decision of the ITI’s Research Committee is final and excludes recourse to law.With their signature,all Applicants, therefore, irrevocably declare they will refrain from taking all and any legal action against the International Team for Implantology (ITI) and all its subsidiaries and affiliates as well as against the ITI Research Committee and/or every individual member of the ITI Research Committee.
  1. The Applicants are not permitted to contact the ITI Research Committee or any member of the ITI Research Committee with regard to the paper, which must remain anonymous from submission until the end of the evaluation process. Failure to comply will lead to disqualification of the Applicants.
  1. Applications are only valid if the first author of the paper submitted is not a Straumann employee.
  1. Applications are only valid if they fulfill the terms and conditions of application and if submitted as described above by the given deadline.
  1. In the event that the André Schroeder Research Prize is awarded to the undersigned, they agree to allow the ITI to refer to the paper in part or in full in ITI publications, press releases, on the ITI website or in publications authorized by the ITI.

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By signing this application form, the undersigned Applicants confirm that they have read, understood and accept the terms and conditions of participation stated in this application form. They specifically warrant that they are the authors of the paper submitted and confirm that the information given in this application form is complete, true and accurate. The undersigned Applicants further warrant that they are responsible for the research carried out for the paper and that such research is original.

First Applicant:

Name (please type or insert in block letters):

______

Place/DateSignature

Further Applicants:

1. Name (please type or insert in block letters):

______

Place/DateSignature

2. Name(please type or insert in block letters):

______

Place/DateSignature

3. Name (please type or insert in block letters):

______

Place/DateSignature

4. Name (please type or insert in block letters):

______

Place/DateSignature

5. Name (please type or insert in block letters):

______

Place/DateSignature

6. Name (please type or insert in block letters):

______

Place/DateSignature

7. Name (please type or insert in block letters):

______

Place/DateSignature

8. Name (please type or insert in block letters):

______

Place/DateSignature

9. Name (please type or insert in block letters):

______

Place/DateSignature

Application Form v1– 2018André Schroeder Research Prize

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