BANDO PROGRAMMA NEUROSCIENZE
MULTICENTRERESEARCH GRANT APPLICATION FORM
FORM “A”: GENERAL INFORMATION
- Coordinator
Name
Title & Position
Institution
Department
Laboratory
Address
Phone
Fax
2. Project
1.Title
2. Acronym
3. Duration (years)
4. Starting date
5. Key words (max. 5)
3. Partners and Centres involved in the study (Max. 5)
- Coordinator
- Principal Investigator and affiliation
- Principal Investigator and affiliation
- Principal Investigator and affiliation
- Principal Investigator and affiliation
Consortium Agreement / YES / NO
4. Previous support by the Compagnia di San Paolo
Previous Support by the Compagnia di San Paolo to the Coordinator and/or the Investigators? / YES / NO
If YES, provide details (Grant holder, project title and duration, amount funded)
5.Abstract
The abstract (Max. 250 words) should be organized in the following sections: (i) State of the art; (ii) Objective and rationale; (iii) Experimental Plan; (iv) Expected results and their relevance.
FORM B1: COORDINATOR
- Curriculum vitae (Max. 500 words,includingbirth place & date and address for correspondence)
2.Selection of the most significant publications in refereed journals (30 max; including all authors, year of publication, full title, journal, volume, first-last page). Mark with an asterisk the 5 more relevant to the project.
- Composition of the research group(including those to be recruited). For each collaborator include the information detailed below. Note:a collaborator can be part of one application ONLY.
COLLABORATOR #1
- Name
- Title
- Current position
- Age
- Role in the project
- Number of months/year dedicated to the project
- Agreement to participate (YES/NO)
- Publications in refereed journals (max. 5 publications including all authors, year of publication, full title, journal, volume, first-last page)
COLLABORATOR #
COLLABORATOR #
......
- Laboratory facilities and resources (Max. 500 words).
Laboratory space
Office space
Major equipment
Clinical resources (if relevant)
Core facilities (if relevant)
Services
Other
5.Other relevant current or pending financial support(for each grant include the information detailed below).
GRANT #
- Title of the research project
- Project Start/End dates
- Granting Agency
- Available/obtained/pending
- Gross amount
- Percentage overlap with this application
-Is there specific funding for this project? (if yes, state the amount of contribution to this project)
GRANT #GRANT #
GRANT #
...... /
.....
FORMS B2-B5(repeat for each principal investigator listed in A3)
PRINCIPAL INVESTIGATOR: “name”
- Curriculum vitae (Max. 500 words,includingbirth place & date and address for correspondence)
2.Selection of the most significant publications in refereed journals (30 max; including all authors, year of publication, full title, journal, volume, first-last page). Mark with an asterisk the 5 more relevant to the project.
- Collaborators in the project(including those to be recruited). For each collaborator include the information detailed below. Note:a collaborator can be part of one application ONLY.
COLLABORATOR #1
- Name
- Title
- Current position
- Age
- Role in the project
- Number of months/year dedicated to the project
- Agreement to participate (YES/NO)
- Publications in refereed journals (max. 5 publications including all authors, year of publication, full title, journal, volume, first-last page)
COLLABORATOR #
COLLABORATOR #
......
- Laboratory facilities and resources (Max. 500 words).
Laboratory space
Office space
Major equipment
Clinical resources (if relevant)
Core facilities (if relevant)
Services
Other
5.Other relevant current or pending financial support(for each grant include the information detailed below).
GRANT #
- Title of the research project
- Project Start/End dates
- Granting Agency
- Available/obtained/pending
- Gross amount
- Percentage overlap with this application
-Is there specific funding for this project? (if yes, state the amount of contribution to this project)
GRANT #GRANT #
GRANT #
GRANT #
...... /
.....
FORM C: RESEARCH PLAN- Background and rationale (Max. 1000 words)
2. Specific aims and preliminary findings (Max. 1000 words)
3. Studydesign and methods (Max. 1500 words)
4. Specific contribution of each Principal Investigator and added valueof the multicentric collaboration to the project(Max. 500 words)
5. Time schedule of the project(Max. 250 words)
6. Cited references (Max. 50; mark those by the applicants withan asterisk)
7. List of abbreviations
8. Lay summary in Italian and English (Max. 250 words for each version)
Italian
English
FORM D
OVERALLBUDGET OF THE MULTICENTRE PROJECT
1.Total cost of the project
YEAR 1 / €
YEAR 2 / €
YEAR 3 / €
TOTAL COST OF THE PROJECT / €
Requested to the Compagnia Di San Paolo / €
From other sources / €
2. Breakdown of the total amount requested to Compagnia di San Paolo
in €
CATEGORIES / YEAR 1 / YEAR 2 / YEAR 3 / TOTAL
Equipment
Materials and supplies
Services
Salaries and wages
Travel expenses
Other
Overhead
TOTAL
3. Partners’ requests and contributions to the research budget from other available sources
COORDINATOR / “name”
Total Cost / €
Requested to the Compagnia di San Paolo / €
Contribution from other sources / €
PRINCIPAL INVESTIGATOR / “name”
Total Cost / €
Requested to the Compagnia di San Paolo / €
Contribution from other sources / €
PRINCIPAL INVESTIGATOR / “name”
Total Cost / €
Requested to the Compagnia di San Paolo / €
Contribution from other sources / €
PRINCIPAL INVESTIGATOR / “name”
Total Cost / €
Requested to the Compagnia di San Paolo / €
Contribution from other sources / €
PRINCIPAL INVESTIGATOR / “name”
Total Cost / €
Requested to the Compagnia di San Paolo / €
Contribution from other sources / €
FORM D1: INDIVIDUAL BUDGET OF THE COORDINATOR
1. Total cost of the project (including the possible contribution from other grants)
YEAR 1 / €
YEAR 2 / €
YEAR 3 / €
TOTAL COST OF THE PROJECT / €
2. Contributions to the research budget from other available grants (please specify)
Grant / €
...... / €
3. Total amount requested to the Compagnia di San Paolo
€
4. Breakdown of the total amount requested to the Compagnia di San Paolo
in €
CATEGORIES / YEAR 1 / YEAR 2 / YEAR 3 / TOTAL
Equipment
Materials and supplies
Services
Salaries and wages
Travel expenses
Other
Overhead
TOTAL
4. Detailed budget breakdown. For each category describe, justify and refer to the specific year.
Equipment
For each item include: 1. Type and model: 2. Cost (enclose offer); 3. Justification for purchasing and use in the project
YEAR 1
YEAR 2
YEAR 3
Materials and supplies
For each yearspecify categories and relative costs
YEAR 1
YEAR 2
YEAR 3
Services
YEAR 1
YEAR 2
YEAR 3
Salaries and wages
For each person include: 1. Cost for person; 2. Position type; 3. Role in the project; 4. Duration of contract.
Travel expenses(specify)
YEAR 1
YEAR 2
YEAR 3
Other (specify)
Overhead (10% Max.)
Il Coordinatore del progetto dichiara, sotto la sua personale responsabilità:
- che le informazioni incluse nella presente richiesta di finanziamento sono complete e accurate;
- che il progetto è conforme alla normativa vigente in tema di ricerca e si impegnerà, in caso di finanziamento, a fornire alla Compagnia le autorizzazioni previste dagli Enti di competenza;
- di farsi garante dell’approvazione da parte dell’Ente di appartenenza, del parere del Comitato Etico laddove necessario, della salvaguardia dei diritti naturali della Compagnia sui prodotti della ricerca (pubblicazioni, utili da trasferimento, brevetti) e della disponibilità per le richieste di controllo della Compagnia;
- di impegnarsi a sottomettere gli interim e final reports;
- di accettare l’utilizzo dei dati personali da parte della Compagnia a soli fini istituzionali, secondo quanto previsto dalla legge 196/2003.
La Compagnia di San Paolo si riserva di prendere contatto con il Coordinatore del progetto per eventuali approfondimenti o chiarimenti sull’iniziativa proposta.
Il Coordinatore del progetto:…………………………………………………….
…………………………………………………….
(firma)
Data ………………………………..
Il Responsabile dell’Ente proponente dichiara di aver preso visione del progetto presentato alla Compagnia e di approvarlo in ogni sua parte.
Dichiara inoltre che l’Ente presso cui si svolgerà la ricerca si impegna formalmente a sostenere il Coordinatore per tutta la durata del progetto, assicurandogli il necessario supporto tecnico e logistico.
Il Responsabile dell’Ente proponente:
…………………………………………………….
…………………………………………………….
(firma)
Data ………………………………..
FORM D2/D5: INDIVIDUAL BUDGET OF PRINCIPAL INVESTIGATOR “name”
1. Total cost of the project (including the possible contribution from other grants)
YEAR 1 / €
YEAR 2 / €
YEAR 3 / €
TOTAL COST OF THE PROJECT / €
2. Contributions to the research budget from other available grants (please specify)
Grant / €
...... / €
3. Total amount requested to the Compagnia di San Paolo
€
4. Breakdown of the total amount requested to Compagnia di San Paolo
in €
CATEGORIES / YEAR 1 / YEAR 2 / YEAR 3 / TOTAL
Equipment
Materials and supplies
Services
Salaries and wages
Travel expenses
Other
Overhead
TOTAL
4. Detailed budget breakdown. For each category describe, justify and refer to the specific year.
Equipment
For each item include: 1. Type and model: 2. Cost (enclose offer); 3. Justification for purchasing and use in the project
YEAR 1
YEAR 2
YEAR 3
Materials and supplies
For each yearspecify categories and relative costs
YEAR 1
YEAR 2
YEAR 3
Services
YEAR 1
YEAR 2
YEAR 3
Salaries and wages
For each person include: 1. Cost for person; 2. Position type; 3. Role in the project; 4. Duration of contract.
Travel expenses(specify)
YEAR 1
YEAR 2
YEAR 3
Other (specify)
Overhead (10% Max.)
Il Responsabile scientifico dell’Unità di Ricerca dichiara, sotto la sua personale responsabilità:
- che le informazioni incluse nella presente richiesta di finanziamento sono complete e accurate;
- che il progetto è conforme alla normativa vigente in tema di ricerca e si impegnerà, in caso di finanziamento, a fornire alla Compagnia le autorizzazioni previste dagli Enti di competenza;
- di farsi garante dell’approvazione da parte dell’Ente di appartenenza, del parere del comitato etico laddove necessario, della salvaguardia dei diritti naturali della Compagnia sui prodotti della ricerca (pubblicazioni, utili da trasferimento, brevetti) e della disponibilità per le richieste di controllo della Compagnia;
- di impegnarsi a sottomettere gli interim e final reports;
- di accettare l’utilizzo dei dati personali da parte della Compagnia a soli fini istituzionali, secondo quanto previsto dalla legge 196/2003.
La Compagnia di San Paolo si riserva di prendere contatto con il Responsabile del progetto per eventuali approfondimenti o chiarimenti sull’iniziativa proposta.
Il Responsabile dell’Unità di Ricerca:…………………………………………………….
…………………………………………………….
(firma)
Data ………………………………..
Il Responsabile dell’Ente proponente dichiara di aver preso visione del progetto presentato alla Compagnia e di approvarlo in ogni sua parte.
Dichiara inoltre che l’Ente presso cui si svolgerà la ricerca si impegna formalmente a sostenere il Responsabile dell’Unità di Ricerca per tutta la durata del progetto, assicurandogli il necessario supporto tecnico e logistico.
Il Responsabile dell’Ente proponente:
…………………………………………………….
…………………………………………………….
(firma)
Data ………………………………..
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