Reg no FS 2.1.6-1870-16

Form (to be submitted to vice-chancellor’s office, all attachments together in one original and 8 copies) no later than 30th of January 2017)

APPLICATION FOR FUNDING 2017

From the foundations administered by Umeå University and distributed by the Faculty of Medicine

(this form is to be used for applications from all foundations apart from the Arnerska forskningsfonden)

Please tick the boxbelow to indicate if you apply as a young scientist

Has enclosed appendix 6: Young scientists (state date of defence of Thesis, year/month/day)

Read the instructions before filling in the form

1.TITLE OF PROJECT

Principal:
I wish to be considered as a young researcher in accordance with the guidelines under point 4
I have received funding from the university’s foundations (State the year of the decision and enclose a copy of the decision with this application) Year / Title/Appointment
/ Department:

2.PROJECT PARTICIPANTS(Applies only to applications for funding from foundations):

Name / Title / Main supervisor (if not a PhD holder)

3. the application is for research within the following field(s)In the boxes below, the principal must indicate which fields the research relates to (part-projects 1 and 2 must relate to different fields. If the project is/projects are of broad relevance, several boxes may be ticked)Applies only to applications for funding from foundations

Asthma/allergy / ALS / Neurology
Occupational therapy / Diabetes / Rheumatology
Paediatrics / Epilepsy / Thorax
Blood research / Cardiovascular / Eye
Cancer / Heart and lung / Ear, nose and throat
Cellmembranes / Infection

3.1 IS THE REASEARCH CONSIDERED AS MEDICAL RESEARCH? The principal must tick yes or no.

YES / NO

An application for funding for all or part of the project has also been made to the following local foundations (including Lions Cancer Research Foundation):

(If not, tick the box)

______

4. ATTACHMENTS (tick the attachments enclosed with the application):

Attachment 1:List of the principal’s publications/reports over the last 5 years. Here the applicant can also list other qualifications that support the application. CV, maximum 1 page(obligatory).

Attachment 2: Scientific report. State the title, amount of funding, and a short summary of the progress of each project that was supported (200 – 400 word). Use the list of publications (attachment 1) to refer to relevant publications. Unpublished material in manuscript form can be presented by means of an attached abstract. Note that each individual project must be accounted forin a separate attachment. All earlier projects must be reported. This attachment carries the most weight in this year’s assessment process and is obligatory if the applicant has been given funding previously.

Attachment3:An account statement (print-out from Raindance) as of 31 December 2016, with amount, listing all the principal’s earlier funding from faculty foundations (obligatory).

Attachment4:Research programme:Must fit on 8 pages (size of font11pt or larger) and be structured as follows. When appropriate the same research programme as used for application to the Swedish Research Council can be used.

I. Introduction and previous results: Describe the background to the study. Include references to literature in the text or refer to the principal’s list of publications over the last five years (attachment 1).

II. Presentation of the problem:State clearly the question at issue and hypothesis.

III. Method/work plan: Give a simple description of the research strategy.

IV. Significance:Describe the significance of the study and its relevance to the field of research.

(obligatory; can be written in Swedish or English).

Attachment5:Funding from the university’s foundations. Decision from the last distribution (obligatory if applicable).

Attachment6: Young researchers: The faculty has the objective to give special support to researchers who have recently gained their PhDs and whose posts will enable them to build up independent research activities. An applicant who has presented a doctoral thesis within a 5-year period (as defined by the date of dissertation and the deadline of his application (note that documented parental leave will be considered) and aims to initiate an independent line of research, may submitan attachment (maximum one A4 page) describing current and planned activities (to be stapled on as the final page of the application). This attachment must summarize previous appointments, current departmental resources, and the planned development of the research group. Young researchers with newly started groups will be assessed using the Swedish Research Council’s criteria for postdoctoral research fellows, wage allowance for a transition to clinical research and post-doctoral stipends for women. Special funding for “young researchers” can only be given once.

5. Information about the principal

Date of birth / Defense of thesis (year/month/day) / Docent (year) / Appointment (date of commencement)

6. department where work will be performed:

7. Research students supervised by the principal to doctoral or licentiate degree, during the last six years:

Name and year / Degree (PhD/Lic) / Main supervisor / Assistant supervisor

8. Applicant’s current external funding(only funding in excess of 100000 SEK per year):

9. Has the principal received one or more grants from Insamlingsstiftelsen för medicinsk forskning or from any other of the faculty’s foundations during the last 3 years?

Yes No

If ”Yes” or if no box is ticked, attachments 2 and 3 are required in order for the application to be considered.

10. Summary of the research programme (maximum 1500 charactersincluding spaces):

11. Popular science description in Swedish (maximum 4500 characters includingspaces):

12. Explain why the project is relevant to one/some of the fields of medicine ticked under point 3. (Maximum 1500 characters including spaces):

13.Calculation of costs (use an attachment if necessary)

14. I hereby pledge that the information given above is correct (principal’s signature)

Approved:...... Signature, Head of DepartmentSignature, Clinical Manager (“verksamhetschef”)

(if applicable)

Clarification of signature Clarification of signature

To be handed in to

Vice chancellor’s office (Registrator), mark the application with FS 2.1.6-1870-16

Registrator

Umeå universitet

901 87 Umeå

Or in the post box by the door to the administrations building.

No later than January 30.

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