Kenneth J. Fyke Award Program

Name of Applicant: ENTER APPLICANT NAME HERE

Kenneth J. Fyke Award Program

Application Form

Overview

Applicants are advised to review the Canadian Blood Services’ Kenneth J. Fyke Award Program Guidelines to ensure alignment of their applications with the program objectives, research priorities, and eligibility criteria.

The application package must be delivered to Canadian Blood Services

by midnight November 30, 2016.

Instructions

It is the applicant’s responsibility to ensure that the complete application package is delivered by the application deadline. All documents must be delivered by email to .

The application package includes the following documents.

Completed Application Form: A single word file that includes the completed 2016 Application Form using the pre-formatted settings.
A scanned copy of the signed Application Form signature page (Section A).
Project Team Member(s) CV: A single PDF of a full Canadian Common CV ( in the CIHR Academic format for all project team members. See Section C for details.

Direct questions about the Canadian Blood Services Kenneth J. Fyke Award Program, including the application process, to the Canadian Blood Services’ Centre for Innovation at .

Kenneth J. Fyke Award Program 2016: Application FormPage 1 of 6

Name of Applicant: ENTER APPLICANT NAME HERE

Section A: General Information

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

APPLICANT
Family Name: / Given Name(s):
ACADEMIC INSTITUTION AFFILIATION
Position:
Department:
University:
Mailing Address (at University):
Phone Number:
Email:
PROPOSED PROJECT
Project Title:
Project Start Date (provide a proposed start date on or within six months of April 1 2017):
Academic institution where research will be performed (if different from above):
AGREEMENT
The undersigned acknowledge that the enclosed application for research funding from Canadian Blood Services represents a study of which the applicant was responsible for the proposal development. If funded, the applicant will assume primary responsibility for the implementation and performance of the proposed study.
The undersigned agree that the general conditions governing the Kenneth J. Fyke Award Program, as set out in the Guidelines, are accepted by the applicant on behalf of the project team and the academic institution.
Applicant / Head of department at academic institution
Name:
Date: / Name:
Date:

Section B: Project Proposal

PROJECT SUMMARY
Provide a summary (200 words max.), in lay terms, of the proposed project, highlighting project objectives and deliverables and describing how the research is aligned with the Kenneth J. Fyke Award Program’s objective, including identified priorities. If the project is approved, this summary may be published on Canadian Blood Services’ website.
PROJECT PROPOSAL
In nine (9) pages maximum (including tables and figures):
(a) Describe the background, rationale, and objectives of the project, including any relevant preliminary findings;
(b) Outline the proposed research methodology, 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 Program’s objective and identified priorities; and
(d) Detail the key deliverables anticipated by the end of the funding period.
A list of selected references may be included in addition to the nine (9) page limit.
ETHICS APPROVAL - Human experimentation
Indicate if the proposal includes research involving human participants and if ethics approval has been applied for or obtained. This information is used for administrative purposes to ensure that research ethics approval is in place prior to the release of funds and is not used to evaluate the merit of the application.
Has ethics approval been applied for or obtained?
☐Yes☐No ☐Not applicable
SEX AND GENDER
Are sex (biological) considerations taken into account in this proposal?
☐Yes☐No
Are gender (socio-cultural) considerations taken into account in this proposal?
☐Yes☐No
Describe how sex and/or gender considerations will be considered in your research proposal.

Section C: Project Team

In the tables below, list all proposed Project Investigators and Project Collaborators. Project Investigators are Principal Investigators affiliated with Canadian Academic Institutions who are requesting Canadian Blood Services funding. Project Collaborators are Principal Investigators who are not requesting funding but who will be collaborating on the project. Do not include trainees and personnel as either Project Investigators or Project Collaborators.

In a separate file, provide a full Canadian Common CV ( in the CIHR Academic format for all identified Project Investigators and Project Collaborators.

PROJECT INVESTIGATORS (Principal investigator requesting funds from Canadian Blood Services)
Name / Position and Institution / Email

Primary Applicant:

Role in project:
2.
Role in project:
3.
Role in project:
PROJECT COLLABORATORS (Principal Investigators not requesting funds from Canadian Blood Services)
Name / Position and Institution / Email
1.
Role in project:
2.
Role in project:
3.
Role in project:

Insert rows as needed.

Section D: Project Budget

Provide a budget for the project. The proposed budget must not exceed $100,000 for one year. Salaries for primary applicants (senior researchers) are not eligible. Funds may be used for trainee stipends, 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: $______

PRIMARY APPLICANT’S BUDGET
BUDGET OVERVIEW
$ Amount Requested
Salaries and benefits
Post-doctoral fellow(s)
Graduate/post-graduate student(s)
Summer student(s)
Technical/professional assistant(s)
Other
Materials and supplies
Equipment
Purchase or rental
Other
Services
Meeting costs
Travel
Other
Total
BUDGET DETAILS
Provide specifications/justifications/comments on the budget (no page limit).
PROJECT INVESTIGATOR’S BUDGET
Project Investigator Name:
BUDGET OVERVIEW
$ Amount Requested
Salaries and benefits
Post-doctoral fellow(s)
Graduate/post-graduate student(s)
Summer student(s)
Technical/professional assistant(s)
Other
Materials and supplies
Equipment
Purchase or rental
Other
Services
Meeting costs
Travel
Other
Total
BUDGET DETAILS
Provide specifications/justifications/comments on the budget (no page limit).

Copy table for other Project Investigators, as needed.

Kenneth J. Fyke Award Program Application Form – 2016 Page 1 of 7