SAMPLE PROPOSAL Transformational Research 2015 DEADLINE: Tuesday, July 7, 2015, 2:00 p.m. EDT Award announcements will be made in September 2015. This Proposal template is an example of the expectations at the Proposal stage of the application process and may be subject to change before the deadline. Do not complete the paper application. Application Number: Principal Applicant: Project Title: Applicant Details Team Members Organizations Primary Contact Information Address: Phone: Email: Role in Project Estimated Time Spent on Project %  Principal Primary 1. Salutation: Applicant Organization:  Co‐Applicant Position Title: First Name:  Collaborator Other Affiliations/
Last Name: Position Titles: %  Principal Address: Primary 2. Salutation: Applicant Organization:  Co‐Applicant Phone: Position Title: First Name:  Collaborator Other Affiliations/ Email: Last Name: Position Titles: Note: Projects are not limited to two team members as laid out on this sample application form; projects may include as many team members as needed for the successful execution of the project. A curriculum vitae (NIH biosketch or equivalent) of five pages or less is required for each team member. Application Number: Principal Applicant: 1 of 9 Application Overview Keywords to describe the proposed work: What type of tool(s) or therapeutic(s) is being developed as the main goal of the project? (Please select only the tool(s) and/or therapeutic(s) that are being developed as a main goal of the project; do not select items that are being used as part of the project, e.g., do not select “Animal Model” unless you are developing a new animal model. There is no benefit to selecting more items than fewer items.) Therapeutic Tool  Biologic  Animal model  Cell therapy  Assay/screen  Electrical brain stimulation  Biomarker  Magnetic brain stimulation  Cell line  Medical device  Clinical assessment instruments  Diagnostic  Small molecule  Imaging technique or reagent  Surgical intervention  New method of drug delivery  Vaccine  Probe  Other Please specify:  Other Please specify: If a therapeutic is being developed, what phase(s) of development does the project cover? (Please select all that apply. There is no benefit to selecting more phases than fewer phases.)  Safety and toxicity in animals  Target validation  Efficacy in animals  Assay development  Other Please specify:  Screening and hits to leads  Lead optimization Research will have a significant impact in which neurodegenerative disease(s) of aging? (Please select all that apply. There is no benefit to selecting more phases than fewer phases.)  Multiple system atrophy  Alzheimer’s disease  Parkinson’s disease  Amyotrophic lateral sclerosis  Progressive supranuclear palsy  Dementia with Lewy bodies  Mild cognitive impairment as prodromal to one  Frontotemporal dementia of the other listed diseases Have you applied to other funding agencies with the same proposed work?  Yes Please specify: (This information will not be used to assess the application.)  No Is this your first time applying for a neuroscience grant from the Institute?  Yes (This information will not be used to assess the application.)  No  Yes Is this your first application for a research grant specifically in the area of  No neurodegenerative diseases of aging? (This information will not be used to assess the application.) Application Number: Principal Applicant: 2 of 9 Project Information 1. Goals and specific aims: 2. Background and significance: Please critically evaluate existing knowledge and identify the gaps that this project is intended to fill. If applicable, please include any existing studies or data or equivalent to identify how this work is building on or improving the knowledge already in the field. Why is it important that the proposed work be carried out? 3. Experimental approach: How will the proposed work be carried out? Please include: central hypothesis, preliminary data, detailed experimental design and methods (including any statistical information and sample sizes), and alternative approaches at critical milestones if needed. 4. Limitations of proposal: What do you consider to be the limitations of this Proposal (this refers to the Proposal overall and is not limited to the experimental approach)? 5. Innovation: What is innovative about the proposed work? Is the creation, improvement, or new application of theoretical concepts, approaches or methodologies, instrumentation or interventions proposed? 6. Impact: How will successful completion of this work accelerate the development of therapeutics for neurodegenerative diseases of aging? What is your general administrative and experimental plan for advancing this line of inquiry to the point of relevance to sufferers of neurodegenerative diseases of aging? 7. Team and environment: Why are the investigator(s), environment and collaborations (if applicable) particularly suited to achieve the aims of the proposed work? 8. Other funding support: What percent of the proposed work is being funded by other grants (0‐
100%)? 9. Location of work: What percent of proposed work is being carried out internationally (0‐100%), and what is involved in this work? If applicable, please explain why this work is not being carried out in Canada. List of publications cited in the application and other publications directly relevant to the proposed work: Please include full citations and PMID. Application Number: Principal Applicant: 3 of 9 Budget Year 1 (please use this same form to complete the budgets for Years 2 and 3, if applicable) Personnel Costs Name Role in Project 1. 2. Laboratory Supplies Description 1. 2. Animal Costs Unit Cost Description Description 1. 2. Other Costs Description 1. 2. Subtotal $ Total $ Number of Units Total $ Number of Units Subtotal Unit Cost Total Number of Units Subtotal Unit Cost Benefits Requested Subtotal Unit Cost 1. 2. Patient Care Costs Estimated Base Salary Salary Time Spent Requested on Project % % Number of Units Subtotal Total Requested Budget Total $ Total $ $ Budget Justification: How do the budget items appropriately support the work proposed? Application Number: Principal Applicant: 4 of 9 Milestones Project Start Date: MM/DD/YYYY Project End Date: MM/DD/YYYY Start‐Up Funding (optional) Description 1. 2. Amount: $ Payment Date: MM/DD/YYYY 1st Tranche of Funding 1. 2. Description Amount: $ Payment Date: MM/DD/YYYY Months from Project Start Date 0‐6 7‐12 13‐18 19‐24 25‐29 30‐36 2nd Tranche of Funding 1. 2. Description Amount: $ Payment Date: MM/DD/YYYY Months from Project Start Date 0‐6 7‐12 13‐18 19‐24 25‐29 30‐36 3rd Tranche of Funding Description 1. 2. 4th Tranche of Funding 1. 2. Description Amount: $ Payment Date: MM/DD/YYYY Months from Project Start Date 0‐6 7‐12 13‐18 19‐24 25‐29 30‐36 Amount: $ Payment Date: MM/DD/YYYY Months from Project Start Date 0‐6 7‐12 13‐18 19‐24 25‐29 30‐36 Application Number: Principal Applicant: 5 of 9 5th Tranche of Funding 1. 2. Payment Date: MM/DD/YYYY Amount: $ Months from Project Start Date Description 0‐6 7‐12 13‐18 19‐24 25‐29 30‐36 6th Tranche of Funding Amount: $ Payment Date: MM/DD/YYYY Months from Project Start Date 0‐6 7‐12 13‐18 19‐24 25‐29 Description 1. 2. (Include additional tranches of funding if needed, i.e., 7th Tranche of Funding, etc.) Notes (if needed): Application Number: Principal Applicant: 30‐36 6 of 9 Supplementary Materials (optional) You may submit supplementary material, including the following:  Photographs, figures, tables cited in the Proposal  Preliminary data  1 manuscript  Pending or granted patents All supplementary material must be directly relevant to the proposed work, and be no more than 20 pages. Any materials beyond 20 pages will not be reviewed. Application Number: Principal Applicant: 7 of 9 Principal Applicant/Institutional Signatures Please ensure the necessary parties sign this page. “Per” signatures cannot be accepted. Signatures can be submitted on separate pages. This Proposal may be executed by the parties in counterparts and may be delivered in electronic format, with all counterparts and electronic transmissions being as effective as a manually executed copy and together will constitute one and the same Proposal. I declare that to the best of my knowledge the statements and other information contained in this application are truthful, complete, and accurate. I further understand that an incomplete application will not be reviewed. Principal Applicant: Signature Print Name Date Official institutional signature of Principal Applicant’s institution: Signature Print Name Date Application Number: Principal Applicant: 8 of 9 Co‐Applicant/Collaborator Signatures Please have all co‐applicants and collaborators sign this page. “Per” signatures cannot be accepted. Signatures can be submitted on separate pages. This Proposal may be executed by the parties in counterparts and may be delivered in electronic format, with all counterparts and electronic transmissions being as effective as a manually executed copy and together will constitute one and the same Proposal. I am aware that I am a collaborator on this grant and I declare that to the best of my knowledge the information contained in this application are truthful, complete, and accurate. Co‐Applicant/Collaborator: Signature Print Name Date Co‐Applicant/Collaborator: Signature Print Name Date Co‐Applicant/Collaborator: Signature Print Name Date Co‐Applicant/Collaborator: Signature Print Name Date Co‐Applicant/Collaborator: Signature Print Name Date Application Number: Principal Applicant: 9 of 9