Download rfa application form - AT Children`s Project

RFA APPLICATION FORM
2015
REQUEST FOR APPLICATION (RFA):
ENABLING DRUG SCREENING FOR ATAXIA TELANGIECTASIA
Please check:
 PHASE ONE: Identification of Cellular Phenotypes and Target Proteins
 PHASE TWO: Assay Development for Screening
Principal Investigator responsible for project
Name:
Institution:
Address:
Telephone:
Email:
Total funds requested for grant:
Proposed grant period (one or two years):
Institution's grants administrative officer
Name:
Title:
Address:
Telephone:
Email:
A-T CHILDREN’S PROJECT
5300 W. Hillsboro Blvd., Suite 105 • Coconut Creek, Florida 33073
Phone: (954) 481-6611 • www.atcp.org
[email protected]
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RFA APPLICATION FORM
2015
Institution's financial officer responsible for reports of expenditures and proposed grant
funds
Name:
Title:
Address:
Telephone:
Email:
Grant payment checks
Payable to:
Mail to:
Name:
Title:
Address:
Institution and/or performance sites where research will be conducted
Name:
Address:
Telephone:
Employer Identification Number (EIN):
A-T CHILDREN’S PROJECT
5300 W. Hillsboro Blvd., Suite 105 • Coconut Creek, Florida 33073
Phone: (954) 481-6611 • www.atcp.org
[email protected]
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RFA APPLICATION FORM
2015
Abstract of project – one page limit
Describe briefly and clearly the nature, objectives, methods and significance to A-T of the
proposed research project.
Summary for lay persons – 200 word limit
Rewrite the abstract in abbreviated form and in terms suitable for presentation to lay persons
(200 word limit). Note that this summary should clearly explain the proposed work to nonscientists, but will not necessarily be presented to individuals with any emotional connection to
A-T. Therefore, there is no need to interject hoped for but unrealistic long-term results or
references to "potential therapies" in an attempt to "sell" the grant.
BODY OF PROPOSAL - 10 page limit (not including references or budget )
Overall objectives:
Hypothesis and specific aims:
Background (previous work by other investigators and applicant):
Rationale for current proposal:
Methods and procedures:
Anticipated problems and limitations:
Data analysis:
References
Budget
Detailed budget
Budget justification
Other financial support of principal and co-investigators
Description of scientific environment
A-T CHILDREN’S PROJECT
5300 W. Hillsboro Blvd., Suite 105 • Coconut Creek, Florida 33073
Phone: (954) 481-6611 • www.atcp.org
[email protected]
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RFA APPLICATION FORM
2015
Names, titles, telephone numbers and e-mails of co-investigators
Attachments

Curriculum Vitae for investigator and co-investigators (include recent, relevant
publications). NIH style Bio sketches are acceptable.

Letters of agreement from co-investigators

If human subjects will be used in the proposed research, include copies of IRB approval
(if already obtained), consent forms and statement of compliance with the NIH Office
of Extramural Research (OER) guidance for research involving human subjects.
Please note that for grant proposals requiring Institutional Review Board (IRB)
approval, funding will be dependent upon and commence after IRB approval of the
study protocol.

If animals will be used in the proposed research, provide a statement of compliance
with American Veterinary Medicine Association and NIH guidelines.
A-T CHILDREN’S PROJECT
5300 W. Hillsboro Blvd., Suite 105 • Coconut Creek, Florida 33073
Phone: (954) 481-6611 • www.atcp.org
[email protected]
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