Phase One: Development and validation of screening methodology (Issued)
The Myotonic Dystrophy Foundation (MDF) is pleased to announce the availability of funding under the first of a two phase request for proposals to conduct a population-based prevalence study in the United States of genetic mutations and pre-mutations[1] responsible for myotonic dystrophy (DM) types 1 and 2 (DM1 and DM2).
Contracting Officer: Sharon Hesterlee, Ph.D, Research Director, MDF
Place of Performance: United States or Canada
Date Issued: April 27th, 2015
Proposals Due:July, 31, 2015, 5:00 PM PDT
Notification of Selection: September 20, 2015
Period of Award:October 1, 2015 – June 1, 2016
Anticipated Overall Award: $50,000 Each, or $75,000 for collaborations involving more than one laboratory
Number of Phase I Awards: One - two
Section 1 – Administrative Information:
Please fill out the fields below, print and add signatures and then scan to submit with your electronic application. If this application involves a collaboration with another intistution please fill out page two..
PROJECT TITLE
FULL TITLE OF RESEARCH PROPOSAL
ABBREVIATED TITLE OF RESEARCH PROPOSAL
PRINCIPAL INVESTIGATOR
NAME TITLE AND POSITION
DEGREES DEPARTMENT
INSTITUTION
STREET ADDRESS
CITY STATE OR PROVINCE
COUNTRY ZIP CODE
TELEPHONE FAX
AMOUNT REQUESTED (first institution if more than one institution is involved)
CERTIFICATION AND ACCEPTANCE
The undersigned agrees to (1) pursue the scientific investigation described in the Research Plan, (2) acknowledge support from the Myotonic Dystrophy Foundation in any publication resulting from an award, and (3) comply with all of MDF’s eligibility requirements set forth in the MDF Fund a Fellow guidelines and this application. Failure to comply with these requirements shall be considered a material breach of this application. Copies of reprints or manuscripts supported by this grant shall be made available to the Myotonic Dystrophy Foundation.
(SIGNATURE OF APPLICANT)
TYPED NAME OFSIGNATOR
(SIGNATURE OF SPONSOR)
TYPED NAME OFSIGNATOR
MAILING ADDRESS FOR CHECKS:
PAYABLE TO .DEPARTMENT .
INSTITUTION CONTACT PERSON
STREET ADDRESS
CITY STATE/PROVINCE AND ZIP
TELEPHONEFAX
EMAIL FEDERAL TAX ID NUMBER
Co-Investigator (if any – if not, leave blank):
Please fill out the fields below, print and add signatures and then scan to submit with your electronic application. If there is a co-investigator, please feel out page two.
CO - INVESTIGATOR
NAME TITLE AND POSITION
DEGREES DEPARTMENT
INSTITUTION
STREET ADDRESS
CITY STATE OR PROVINCE
COUNTRY ZIP CODE
TELEPHONE FAX
AMOUNT REQUESTED(second institution)
CERTIFICATION AND ACCEPTANCE
The undersigned agrees to (1) pursue the scientific investigation described in the Research Plan, (2) acknowledge support from the Myotonic Dystrophy Foundation in any publication resulting from an award, and (3) comply with all of MDF’s eligibility requirements set forth in the MDF Fund a Fellow guidelines and this application. Failure to comply with these requirements shall be considered a material breach of this application. Copies of reprints or manuscripts supported by this grant shall be made available to the Myotonic Dystrophy Foundation.
(SIGNATURE OF APPLICANT)
TYPED NAME OFSIGNATOR
(SIGNATURE OF SPONSOR)
TYPED NAME OFSIGNATOR
MAILING ADDRESS FOR CHECKS:
PAYABLE TO .DEPARTMENT .
INSTITUTION CONTACT PERSON
STREET ADDRESS
CITY STATE/PROVINCE AND ZIP
TELEPHONEFAX
EMAIL FEDERAL TAX ID NUMBER
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