Application for Post-Doctoral Fellowship
2016 Competition
Checklist Your application must include:
Application for Post-Doctoral Fellowship
Appendix A – Sponsors (page 13)
Appendix B – Declaration by applicant and supervisor (page 14)
Appendix C – Sponsor’s assessment form (provided by three (3) sponsors)
1. Sponsor’s Name
Attached
To be forwarded
2. Sponsor’s Name
Attached
To be forwarded
3. Sponsor’s Name
Attached
To be forwarded
Letters
Letter from proposed supervisor confirming acceptance of candidate and research proposal
Attached
To be forwarded
Written proof of offer of permanent position (if applicable)
Attached
To be forwarded
Attached
To be forwarded
Proof of institution’s contribution to Krescent Award
(Condition of Eligibility Form)
CV module for principal applicant
CV module(s) for supervisor(s)
Up to five (5) publications from the past five years, relevant to this proposal, may be appended
Proof of permanent position (if applicable)
The above-mentioned letters and Appendix C (available on KRESCENT website) from three (3) sponsors must be
received by the competition deadline.
The applicant must submit a PDF copy of the full application (including all signatures and addenda) by email to
chris.marquis@kidney.ca no later than February 15, 2016 by 11:59 pm EST.
Applications can only be submitted by email.
Please refer to the competition guidelines for instructions on preparing electronic files.

It is the responsibility of the applicant to ensure that each item be completed or where allowed is forwarded within
the appropriate time. Incomplete applications will not be considered.
___________________________________________________________________________________________________________
PDF Checklist (10/2015)
Disponible en français
Application for Post-Doctoral Fellowship
2016 Competition
Candidate
Surname
Given Name
Project Title
Location where research will be conducted
Institute
Department
Faculty
Institute which will administer the funds
Administrative Officer
Surname
Address
Telephone
Given Name
Email
Primary Supervisor
Surname
Given Name
Secondary Supervisor
Surname
Given Name
Citizenship
Canadian
Permanent Resident
Preferred language of correspondence
English
Other
Country
Period of support requested
French
Have you applied to the KRESCENT program before? Yes
2 Years
3 years
Year of Competition
No
Signatures
It is agreed that the general conditions governing grants and awards as outlined in the Guidelines and Regulations apply to any grant or
award made pursuant to this application and are hereby accepted by the applicant(s) and the applicant’s employing institution.
Primary Supervisor
Secondary Supervisor
Name and Address
Name and Address
Head of Department at Proposed
Training Location
Name and Address
Email:
Email:
Email:
Signature

Signature

Signature
Date
Date
Date
Candidate
Name

Signature

Date
_________________________________________________________________________________________________________________________
2016 PDF – Section 1 – General Information
Page 1 of 14
Name of Candidate
Themes
Indicate a primary theme classification by typing in the number 1 next to the selected theme. Indicate a second, third and fourth theme
classification only where the substance of the award application significantly overlaps more than one theme (use numbers 2, 3 and 4 to
indicate the selections in order of importance).
Biomedical research
Clinical research
Research respecting health systems and health services
Research on societal, cultural and environmental influences on health and the health of populations
Choose appropriate category for this proposal (only one category)
Acute Kidney Injury
Genetics
Organ Donation
Cancer
Glomerulonephritis
Quality of Life
Chronic Kidney Disease
Hypertension
Transplantation
Diabetes
Kidney Biology
Urology
Dialysis
Kidney Development
Water, Salt and Calcium
Handling by the Kidney
Indicate if the project involves

Human Subjects
Yes
No
Animal Care Form
Yes
No
A requirement for containment
Yes
No
Human Stem Cell Research
Yes
No
Level 1
2
3
4
All applicable certificates must be provided to the KRESCENT program
Descriptors
Provide a maximum of 10 keywords to describe this research project, the techniques to be employed and the disease(s), which will be
impacted by this research.
Do you agree to the release of the information on page 1 and 2, the summary of research and lay abstract to other organizations for the
purpose of determining potential eligibility for other sources of funding?
Yes
No
_________________________________________________________________________________________________________________________
2016 PDF – Section 1 – General Information
Page 2 of 14
Name of Candidate
Degree in progress
Degree Type
Degree Name
Department
Institution
Qualifications, certificates and licenses in progress
Start Date
Expected Date
of Completion
MM/YYYY
MM/YYYY
Start Date
Expected Date
of Completion
MM/YYYY
MM/YYYY
With this award are you proceeding or planning to proceed to any additional degree, diploma and specialty certification?
No
Degree sought
Degree Type
Yes
(please specify)
Degree Name
Department
Institution
Start Date
Expected Date
of Completion
MM/YYYY
MM/YYYY
MM/YYYY
MM/YYYY
Training
Indicate the expected duration of the proposed training
Training (clinical and research) to be completed
MM/YYYY
Is it your intention to obtain a permanent position in Canada?
Have you been offered a permanent position?
Yes
Yes
Please attach proof.
No
No
_________________________________________________________________________________________________________________________
2016 PDF – Section 1 – Degrees
Page 3 of 14
Name of Candidate
Only to be completed by candidates proposing training outside of Canada:
Is it your intention to obtain a permanent position in Canada as a research scientist?
Yes
No
Please describe the factors that have influenced your decision:
Note: If you are proposing training outside of Canada, your supervisor(s) must complete the Supervisory Experience
Form also available on the KRESCENT website. This form must be included with your supervisor’s CV.

_________________________________________________________________________________________________________________________
2016 PDF – Section 1 – Training Outside Canada
Page 4 of 14
Name of Candidate
Training Expectations
Provide an overview of your reasons for applying to the KRESCENT program. Explain how you think the KRESCENT program will help
you in establishing an independent research career. Please include how your research program lends itself to:


Formation of collaborative research teams or networks
Translational initiatives involving other research themes (e.g. biomedical research, clinical research, research respecting
health systems and health services, and research on societal, culture and environmental influences of health and the health of
populations)

Establishment of your long-term career goals (include relevance to kidney disease)
No additional pages may be added.
_________________________________________________________________________________________________________________________
2016 PDF – Section 2 – Training Expectations
Page 5 of 14
Training Expectations (continued)
_________________________________________________________________________________________________________________________
2016 PDF – Section 2 – Training Expectations
Page 6 of 14
Name of Candidate
Proposed Training Program
Please complete this section in collaboration with your proposed supervisor. Both you and your supervisor should sign
at the bottom of page 10 to confirm the accuracy of the proposed training program.

Project Title
Summary of Research Project
Include specific research hypotheses and describe the candidate’s own role in the project. This summary should be written in general
scientific language. Use the space below for the text part of your research proposal. DO NOT submit the text part of your
proposal as a separate file. ONLY the necessary references, tables, figures, and other graphics can be submitted as a separate
PDF document. Text should be single-spaced, Arial (regular), 11 point. No additional pages may be added.
_______________________________________________________________________________________________________________________
2016 PDF – Section 3A – Summary of Project
Page 7 of 14
Summary of Research Project (continued)
_______________________________________________________________________________________________________________________
2016 PDF – Section 3A – Summary of Project
Page 8 of 14
Name of Candidate
Mentorship
The KRESCENT program seeks to develop the next generation of Canadian kidney research leaders. Mentorship is an important
component of the training experience that will facilitate achievement of this goal. In this section, the trainee’s supervisor should describe
the institutional mentorship program, including the frequency and content of supervisor / trainee meetings, advisory committees (if
applicable), and other educational activities (e.g. journal clubs, seminars, etc.). The trainee’s professional responsibilities, including
involvement in other research projects or other duties, should also be described.
_______________________________________________________________________________________________________________________
2016 PDF – Section 3B – Mentorship
Page 9 of 14
Name of Candidate
Describe the space, facilities and personnel support, which will be available to the candidate. What operating funds are available to
support the proposed research project?
The KRESCENT program requires that 80% of the candidate’s time and effort will be devoted to the research project and clinical
activities upon which the research project(s) are immediately dependent. Describe all the activities undertaken by the candidate other
than direct work on the proposed research project (e.g. teaching courses, supervision, seminars, and clinical activities). Indicate the
percentage of time to be spent on each activity using whatever timeframe (i.e. per week, month, and year) that best describes the
involvement.
This summary of research proposal was written by:
Candidate
Proposed Supervisor(s)
Both
The undersigned agree that this accurately describes the training program.
Primary Supervisor

Secondary Supervisor

Candidate

_______________________________________________________________________________________________________________________
2016 PDF – Section 3C – Mentorship
Page 10 of 14
Name of Candidate
Lay Title
Lay Summary (suitable for the preparation of a press release)
A complete structured lay summary with a clear explanation of how the research proposal is relevant to the mission of The Kidney
Foundation of Canada. The lay summary should indicate how your research, ultimately can improve personal health, the health of
population and/or the health delivery system. It must be written in everyday language at a level no greater than “Grade 10”. Use
analogies, simplifications, and generalizations rather than scientific and technical terms. This information will be used in
communications to the volunteers, donors and public about research supported by the Foundation. No additional pages may be
added.
_______________________________________________________________________________________________________________________
2016 PDF – Section 3 – Lay Summary
Page 11 of 14
Name of Candidate
Media Guidelines
The KRESCENT program Post-Doctoral Fellowship recipients and supervisors must advise the National Director of
Research of any proposed activities that may have media relations implications related to the work supported by the
KRESCENT Program. Copies of the relevant materials (i.e. media releases, media backgrounders, etc.) should be
submitted to the National Director of Research for approval in advance of the activity to:
Elisabeth Fowler, MBA
National Director of Research
The Kidney Foundation of Canada
310-5160 Décarie Blvd.
Montréal, QC H3X 2H9
E-mail: elisabeth.fowler@kidney.ca
The above would not apply to papers presented at various scientific meetings, or when there is casual discussion with the
news media on matters not related to the KRESCENT program Post-Doctoral Fellowship.
Applicant Consent Form For Use and Disclosure of Personal Information
Provided to the KRESCENT Program for Peer Review
The KRESCENT program seeks your certification that you have been informed that all the
information supplied in this application will be made available to KRESCENT program
personnel responsible for managing the peer review process to review applications, to
administer and monitor grants and awards, to compile statistics and to promote kidney
research in Canada.
Information supplied in the application will be made available to Peer Review Committees
composed of experts recruited from the academic, public and private sectors. Applications may
also be transmitted to external reviewers.
Information supplied in the application may also be made available to the Program Steering
Committee for relevancy and funding decisions.
I, the undersigned, do hereby give consent to the use and disclosure of the information
contained in my application for the purposes as herein described. I understand that I may
withdraw my consent at any time and that it will become effective upon its receipt by the
KRESCENT program. Further, I agree to the Media Guidelines should I be awarded a
KRESCENT program Post-Doctoral Fellowship.

________________________________________
Signature of Applicant

________________________________________
Primary Supervisor
______________________
Date
______________________
Date
_______________________________________________________________________________________________________________________
2016 PDF – Section 4 – Media Guidelines
Page 12 of 14
Appendix A
Sponsors
2016 Competition
Name of Candidate
Sponsors
Candidates must ask three individuals to complete the Sponsor’s Assessment Form (see Appendix C available on the KRESCENT
website). These should include (if applicable) assessments from each of your two most recent research supervisors. One of these
assessments should be from your PhD supervisor.
Give the names of the individuals whose assessments accompany this application. Note: additional assessments will not be
considered.
Name of Sponsor /
Current Position Held
Institution
Relationship to Candidate
1.
Attached
To be forwarded
Attached
To be forwarded
Attached
To be forwarded
2.
3.
_________________________________________________________________________________________________________________________
2016 PDF – Appendix A – Sponsors
Page 13 of 14
Appendix B
Declaration by Applicant and Supervisor
for Post-Doctoral Fellowship
2016 Competition
Declaration by Applicant
I,
, declare that I have read the Guidelines for application to and Curriculum description of the
KRESCENT program and that the information provided by me is true and complete. I recognize that it is
my responsibility to provide all necessary documentation to support my application to the KRESCENT
program. If I am admitted to the KRESCENT program, I agree to comply with the rules and conditions of
the KRESCENT program as described in the Guidelines and the Curriculum description.

________________________________________
Signature of Applicant
________________________
Date
Declaration by Primary Supervisor
I,
, declare that I have read the Guidelines for application to and Curriculum description of the
KRESCENT program and that the information provided in this application is true and complete.
If
is admitted to the KRESCENT program, I agree to comply with the rules and conditions of the
KRESCENT program as described in the Guidelines and Curriculum description.

________________________________________
Signature of Primary Supervisor
________________________
Date
_________________________________________________________________________________________________________________________
2016 PDF – Appendix B – Declarations
Page 14 of 14