Pan-American Ophthalmological Foundation

2012 Allergan Latin American Research Incentive Award in Glaucoma

Application Form

Receipt Deadline: March 23, 2012

Allergan Latin American Research Incentive Award in Glaucoma
In conjunction with Pan-American Research Day
May 5, 2012
A pioneer initiative by Allergan to create an exclusive award for Latin America, with the objective of recognizing and awarding researchers for their research work aimed at increasing the diagnosis of glaucoma in the region and improving its control.
Submission deadline - March 23, 2012
Submit all requested materials to . Write "Allergan Glaucoma Award Submission" in the subject line. The winning papers will be presented at Pan-American Research Day, Saturday, May 5, 2012.
Award
As an ophthalmology partner, Allergan aims to foster scientific research in Glaucoma in Latin America. Papers will be evaluated by a jury panel composed of recognized specialists in the field.
Four papers will be selected for the Award in risk factors, diagnostics or pathology of glaucoma. The four award-winning studies will receive:
1st place - US$5,000
2nd place - US$4,000
3rd place - US$2,000
4th place - US$1,000
Eligibility
  • Scientific papers or posters accepted forARVO 2012
  • Candidates shall have earned a Medical degree by the deadline for submitting studies
  • The main author will be the representative of the paper in the event it wins an award
  • The main author should be from Latin America and be afilliated with a Latin American institution. The study, however, may be done in other centers.
Submission Criteria
Papers to be submitted shall comply with all the following requisites:
  • Submission form duly filled out and signed (personal data, address, information about the paper)
  • Digital photo of the author (taken within the past year), in either 3x4 or 5x7 format
  • Letter of acknowledgment issued by each member of the study recognizing the main author of the paper, for purposes of receiving the reward
  • Statement declaring that the paper has not been published
  • Resume/CV of the main author
  • Copy of the main author's diploma
  • Abstract, containing: title, authors, descriptive summary and conclusions. Size: 1 page. In English
  • Text, containing: title, authors, introduction, methods, results, discussion/comments, conclusions and references (*). In English.
  • Submit all materials to , with Allergan Glaucoma Award Submission in the subject line.
* standard size complying with the standard defined by the organizing committee (8.5x11, 1 inch margins, double spaced). Follow the publishing instructions of the American Journal of Ophthalmology.
Evaluation Critieria
The evaluation of papers will follow a specific breakdown that will be reviewed by each member of the jury panel:
  • Exclusion criterion
  • Assessment of methodology applied
  • Evaluation breakdown
  • Clinical contribution ...... 40%
  • Originality ...... 40%
  • Discussion ...... 20%
Award Ceremony
The four winners will participate in the scientific program of Pan-American Research Day (PARD 2012), presenting their papers. The four winners will participate in the awards ceremony that will take place at 5:30 pm on Saturday, May 5,2 012, at the Renaissance Hotel in Fort Lauderdale, Florida, the day prior to ARVO 2012.

Type all Information

PAAO ID: (please contact PAAO Office if you don’t know your membership ID number)

Name of Applicant/Main Author:

First Name, Middle Initial, Last Name (s)

Degree(s)

MD, PhD

Mailing Address:

City: State/Providence:

Country: Zip:

Office Phone: () Fax Number: ()

Home Phone: () Birth Date: / /

mmddyyyy

Email: Citizenship:

ARVO Acceptance/Event code:

Title of work accepted for presentation at ARVO:

Abstract (same as appears on ARVO webpage)

APPLICATION MATERIALS:

  1. Submission form (this form), duly filled out and signed (personal data and address information for the main author).
  2. Digital photo of the main author (taken within the last year), in either 3x4 or 5x7 format (jpg, gif or tif).
  3. Letter of acknowledgment issued by each member of the study recognizing the main author of the paper, for purposes of receiving the award.
  4. Statement declaring that the paper has not been published.
  5. Resume/CV of the main author.
  6. Copy of the main author’s diploma.
  7. Abstract, containing: Title, authors, descriptive summary and conclusions. Size: 1 page. English only.
  8. Text, containing: title, authors, introduction, methods, results, discussion/comments, conclusions and references (*). English only.
    (*) standard size complying with the standard defined by the organizing committee (8.5x11, 1 inch margins, double spaced).

APPLICANT AGREEMENT

I have read and accepted the above terms and responsibilities for the Allergan Latin American Research Incentive Award in Glaucoma.

(A) I understand that noncompliance will be grounds for termination of the award.

(B) I assume entire responsibility and hereby agree to protect, indemnify, defend, and save the Pan-American Ophthalmological Foundation (PAOF) and the Pan-American Association of Ophthalmology (PAAO) and their employees and agents, harmless against all claims, losses and damages to persons or property, governmental charges, or fines and attorney’s fees arising out of or caused by my participation in the Allergan Latin American Research Incentive Award in Glaucomaprogram.

Applicant’s Signature: Date

Disclaimer: Employees of the Pan-American Association of Ophthalmology (PAAO), Pan-American Ophthalmological Foundation (PAOF), members of the PAAO Executive Committee, members of the PAOF Board of Directors, their immediate family members and members of the same household, whether related or not, are not eligible to apply for scholarship/fellowship funding. All scholarships are subject to federal laws and regulations and are void where prohibited by law or regulation. Applicants agree to abide by the terms of these official rules and by decisions of the Review Committee which are final and binding on all matters pertaining to the scholarship/fellowship. The PAAO & PAOF reserve the right to disqualify any applicant that they determine, in their sole discretion, to be ineligible to participate in the scholarship/fellowship program. Individuals who have previously received scholarship/fellowship funding are ineligible to apply for additional scholarships/fellowships/funding.

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