DORIS DUKE CHARITABLE FOUNDATION
CLINICAL SCIENTIST DEVELOPMENT AWARD 2012
Nomination Submission Instructions
Institutions must submit their candidate nominations using the foundation's online system on
or before 5 pm EST on November 16, 2011. Each U.S. accredited, degree-granting institution
may nominate up to two candidates. We strongly encourage institutions to nominate women
and under-represented minorities in medicine, including Blacks or African Americans,
Hispanics or Latinos, American Indians, Alaskan Natives, and Native Hawaiians.
To submit nominations, gather:
1. All the required information listed on the “Nomination reference sheet”.
2. The name and contact information (telephone and e-mail) for the person to be contacted
with questions about the institution's nominations
3. The tax ID number for the Grant receiving organization that will accept and administer the
award. The organization must be exempt from federal income taxation as an organization
described in section 501(c)(3) of the Internal Revenue Code of 1986, as amended (the
"Code"), and must not be a private foundation or a Type III supporting organization as
defined in Section 509(a) of the Code.
4. A signed letter from the Dean of the degree-granting institution confirming the
nominations. This is not a letter of recommendation and will not be forwarded to the
review panel. It is strictly a confirmation of the institution's nominees. This signed letter
must be in PDF format.
5. An NIH format biosketch for each of the nominees. The biosketches must be in PDF format.
Then go to the DDCF Medical Research Program website at http://www.ddcf.org/mrp-csda,
where you will find a hyperlink to the online nomination system.
Nominations will only be accepted if submitted through our website. It is the responsibility of
the institutions to ensure that candidates nominated meet all of the eligibility requirements.
Nominations are final upon electronic submission; the replacement of nominees will not be
permitted.
2012 Clinical Scientist Development Award Program
NOMINATION REFERENCE SHEET
DO NOT SUBMIT THIS FORM
This tool will allow you to collect the information that will be required for the ONLINE submission of nominations
Nominee information
First Name
MI
Degree(s)
Last Name
Institution
Department
Address
City
Phone number
State
email address
Zip code
AL
Most recent fellowship completion date
First faculty-level appointment title (e.g., Instructor, Assistant Professor)
First faculty appointment date
Institution of first faculty appointment
Current faculty-level appointment date
Current faculty-level appointment title
Nominee biographical information
The Doris Duke Charitable Foundation values the diversity of the nominees. The information under this section is collected ONLY to measure progress in the
nomination of diverse applicants. These biographical data about the nominee are for statistical purposes only, will only be described in aggregate and will not be
provided to the review panel. The information provided will be anonymous and will not affect the nominee's standing in the process. These data are for
statistical purposes only and will only be described in aggregate. Individual information will be kept on a secure server.
Year of birth
Gender
Ethnicity
Race
Race (other)
Nominee proposal information
Primary disease area
Clinical Research type
Research approach
Keywords
Tentative proposal title
Clinical Research type
Basic discovery research
Definition/examples
Investigations to increase basic knowledge and
understanding; not aimed at uncovering the causes of human disease
Etiology/Mechanisms of Disease Studies of the origins and causes of disease
Prevention
Studies of nutrition, behavioral change, chemoprevention, vaccines
Detection/Diagnosis/Prognosis
Biomarker discovery, technology development, predictive models
Treatment
Discovery and development of new therapies; phase 1-3 clinical trials of therapeutics or interventions
Outcomes Research
Health services research, effectiveness research, Phase 4 trials, educational research, cost analysis,
bioethics
Scientific Model Systems
Resource development only; development of cell culture models, computer models, etc.
Other information
Upon logging into the nominations submission website, you will also need
- Contact information (telephone and email) for the person to be contacted with questions about the institution's nominations
- Contact information for the Dean of the degree-granting institution
- A signed letter from the Dean of the degree-granting institution, in PDF format, confirming the nominations. This is not a letter of
recommendation and will not be forwarded to the review panel.
- NIHformat biosketches for the nominees, in PDF format.