Dystonia Medical Research Foundation
Dystonia Fellowship Application – Year 2005
Dystonia is a neurological movement
disorder characterized by involuntary
muscle contractions which can result in
abnormal movements or postures.
Dystonia can affect any part of the body
including the arms and legs, trunk, neck,
eyelids, face, or vocal cords.
Fellowship Objective
A two-year Fellowship of up to $50,000
per year is designed to assist postdoctoral students establish careers in
research relevant to the field of dystonia.
The Dystonia Foundation supports
hypothesis-driven research at the
genetic, molecular, cellular, systems or
behavioral levels that may, directly or
indirectly, lead to a better understanding
of the pathophysiology of dystonia or to
new therapies for dystonia. Although
primary generalized dystonia is of great
interest to the Foundation, we also
support studies on the focal dystonias
such as spasmodic torticollis,
blepharospasm, and spasmodic
dysphonia, as well as occupational and
secondary dystonias.
Fellowships are offered at up to $50,000
per year for a period of two years, with
funding for the second year contingent
upon evidence of satisfactory progress
in a detailed 9-month progress report.
Eligibility
The applicant seeking Foundation
funding must be employed at a nonprofit organization or institution (each
referred to as a “grantee institution”)
within the United States, Canada, and
those foreign countries where
supervision of grant administration is
possible. Such grantee institution must
sign this grant application (and thereby
agree to the terms and conditions herein)
by signing it through its duly authorized
representative. If the Application is
approved, the grantee institution will be
the direct payee of the Foundation’s
funding (and receive such funding on
behalf of the recipient and will be
responsible for disbursing such funds in
support of the applicant’s research).
Resources
Tissue samples and reagents related to
dystonia previously collected or
developed by Foundation-funded
investigators may be made available to
other investigators through the
Foundation solely for noncommercial
research purposes. Brain tissue from
dystonia patients may be obtained from
the Brain and Tissue Bank for
Developmental Disorders at the
University of Maryland.
Application Process
1. Complete the application including a
reference letter from the applicant’s
mentor. The letter should describe to
what extent the proposal was written
independently by the applicant. A letter
of recommendation from a
scientist/clinician who is not a mentor of
colleague of the applicant should also be
included with the application.
2. Submit (1) one original application
and (1) one electronic copy in PDF or
MS Word formats to the Headquarters
office no later than December 30, 2004.
Budget Allowances and Funding
Up to $50,000 will be awarded for each
of the two consecutive years. Funding
for the second year will be continued
with evidence of satisfactory progress in
a detailed 9-month progress report. The
budget should reflect costs for salary,
travel, and dystonia-relevant research.
Funds will be disbursed quarterly on the
30th of March, June, September, and
December.
Award Process
Each Application will be reviewed,
together with competing proposals, by
the Foundation's Scientific Advisory
Board (SAB). To the extent possible,
review of Applications for Acceleration
Projects will be expedited using a
committee of the SAB.
The SAB will evaluate and rank the
proposals on the basis of scientific merit
and other factors as determined by the
SAB, in its sole discretion. The Board of
Directors will make the final award
decisions, in its sole discretion. In
connection with awards, funds will be
disbursed in quarterly installments on or
about the 30th of March, June,
September, and December. All
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disbursements are subject to the
availability of funds.
Research Guidelines
1. Recombinant DNA Research and
Animal Welfare. Foundation-funded
research will be conducted in
compliance with current U.S. National
Institutes of Health Guidelines for
Recombinant DNA Research and the
U.S. Public Health Service Policy on
Humane Care and Use of Laboratory
Animals.
2. Human Subject Protection. For all
investigations involving human subjects,
approval by the grantee institution’s
human investigation committee is
required.
Progress Reports
Recipient will submit a progress report
nine months after receipt of the first
payment, a final report five months
after receipt of final payment and, if
the award is renewed for a third year,
an interim progress report on the
anniversary of the first progress report.
Progress reports must include a brief
lay summary suitable for publication in
the Foundation newsletter. At the
Foundation’s request, recipients will
also make a presentation about the
significance and progress of their work
to a meeting of the SAB and lay
Boards of the Foundation.
Publication of Research Results
The Foundation expects grant
recipients to publish the results of
Foundation-funded research in an
expeditious manner in peer-reviewed
scientific journals. The final report
required herein must include a plan for
fulfilling this obligation within one
year after the end of the grant period.
Future funding of projects may be
influenced by the extent to which a
recipient fulfills this obligation.
Recipient will: (i) acknowledge the
Foundation in any written work (e.g.,
publication or meeting abstract) and in
any oral presentation that contains
results of research supported by the
Foundation; (ii) promptly notify the
Foundation of any such written work
or oral presentation; and (iii) promptly
Dystonia Medical Research Foundation
Dystonia Fellowship Application – Year 2005
send three copies of any reprints to the
Scientific Director of the Foundation.
Invention Reporting
All inventions, research tools and other
materials, discoveries and
improvements discovered, conceived
or first reduced to practice in the
performance of research supported in
whole or in part by the Foundation
(“Invention”) will be reported in
writing to the Foundation in the next
progress report due hereunder. The
Foundation will also be promptly
notified in writing of the filing of any
patent application for an Invention, any
patent being issued, and of any license
or other agreement concerning an
Invention prior to execution.
Ownership of Inventions
Unless otherwise provided herein, the
grantee institution will own all
Inventions and will not transfer
ownership to any third party, other
than the United States government, if
required by federal regulations.
Availability of Research Materials
Research tools and other materials
developed with Foundation support
must be made available for
noncommercial research purposes to
other investigators, including on a noncollaborative basis, within a year after
funding ends, or immediately after
acceptance of publication of findings
in a peer-reviewed journal, whichever
occurs first. Materials include, without
limitation, novel cell lines, breeding
stock of experimental animals and
reagents.
and biographical information on the
Dystonia Foundation website or in the
Dystonia Dialogue newsletter, and in
any reproductions thereof, and waives
any right to inspect or approve the
form and use thereof.
Duplication of support
The applicant hereby assures the
Foundation that this project is not
receiving, and will not receive, other
funds to support any part of it. In the
event that the recipient is currently
funded, expects to be funded in the
future or has applied for funding from
other sources, recipient must disclose
all other sources on the “Other Funding
Sources” form. After beginning the
project, any funding received by the
recipient that will be used to support
any research that is being supported by
the Foundation must be disclosed
immediately. Under any
circumstances where there is or has
been duplication of support, the
Foundation reserves the right to
discontinue all funding and other
support.
Unallowable Costs
The following costs are not allowable
under the Foundation grant programs:
a. Institutional overhead (indirect
costs).
b. New construction and alterations or
renovations of existing facilities.
c. Consultant fees, unless specified in
the original grant application.
d. Travel costs.
Payee
Recipient will provide the name of the
grantee institution or institutions to
whom the funding checks are to be
made payable and indicate where the
checks are to be sent.
Photograph
Recipient will provide a recent
photograph of himself/herself and
irrevocably grants to the Foundation
and anyone authorized by the
Foundation the unlimited right to
publish his/her name, likeness, picture
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Dystonia Medical Research Foundation
Dystonia Fellowship Application – Year 2005
.
Submit 1 original and 1 electronic
copy to:
Applicant Information
Mahlon R. DeLong, M.D.
_________________________________________________________________________________ Dystonia Medical
Name of Principal Investigator
Research Foundation
One East Wacker Drive
_________________________________________________________________________________
Suite 2430
Institution
Chicago, IL 60601 USA
_________________________________________________________________________________ Phone: 312-755-0198
Fax: 312-803-0138
Mailing Address
Web site: www.dystonia-
foundation.org
_________________________________________________________________________________
Phone
Fax
Electronic copies should be sent to
_________________________________________________________________________________
E-mail
jroosevelt@dystoniafoundation.org
Deadline: December 30, 2004
Proposal Information
____________________________________________________________________________________________________
Title of Proposal
____________________________________________________________________________________________________
Dates of Proposal
Year 1
Year 2
Total Requested (US$)
____________________________________________________________________________________________________
Are human subjects involved?
If so, has Internal Review Board approved the research?
Approval Date
Payment Information
____________________________________________________________________________________________________
To whom check is made payable
Name of Contact Person
____________________________________________________________________________________________________
Institution
____________________________________________________________________________________________________
Mailing Address
Agreed and acknowledged:
By:_________________________________________________________________________________________________
Print Name of Principal Investigator
____________________________________________________________________________________________________
Signature of Principal Investigator
Date
By:
____________________________________________________________________________________________________
Print Name of Grantee Institution
____________________________________________________________________________________________________
Print Name and Title of Grantee Institution’s authorized representative.
____________________________________________________________________________________________________
Signature of Grantee Institution’s authorized representative.
Date
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Dystonia Medical Research Foundation
Dystonia Fellowship Application – Year 2005
Guidelines
We are particularly interested in hypothesis-driven research which is likely to yield positive results. Please prepare your
proposal, insofar as possible, according to the following recommended outline:
1. Specific Aims of the proposal
2. Rationale of proposal and relevance to dystonia
3. Research methods and procedures
4. Bibliography
5. Biographical sketch
6. A reference letter from the applicant’s mentor. (Should mention to what extent the proposal was written by applicant)
7. A reference letter from a scientist/clinician who is not a mentor or colleague of the applicant.
Limit your narrative (Specific Aims, Rationale/Relevance, and Methods/Procedures) to no more than 4 pages (excluding
submitted articles, letters of recommendation, and the Foundation's application.)
Use 11- or 12-point type for the application.
Submit the original application and 1 electronic copy in PDF or MS Word formats to the Foundation for review by the
Scientific Advisory Board.
Abstract of Proposed Research (not to exceed 200 words):
If necessary, use additional sheet of paper
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Dystonia Medical Research Foundation
Dystonia Fellowship Application – Year 2005
Budget
$50,000 will be awarded for each of two consecutive years. The budget should reflect the following costs: salary, travel, and
dystonia-relevant research. Fellowships will not include institutional overhead or indirect costs.
Item
Personnel
First Year
Equipment (itemize)
Supplies (itemize)
Other Expenses (itemize)
Total
Justification for major budget items:
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Second Year
Total
Dystonia Medical Research Foundation
Dystonia Fellowship Application – Year 2005
Career Goals (not to exceed 250 words):
If necessary, use additional sheet of paper
How did you become interested in the study of dystonia and why is this fellowship important to you?
Training Environment (not to exceed 250 words):
If necessary, use additional sheet of paper
Describe the training environment, including your mentor’s background and interests. [Please include a biographical sketch
of mentor.]
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Dystonia Medical Research Foundation
Dystonia Fellowship Application – Year 2005
Biographical Sketch
____________________________________________________________________________________________________
Name
Position/Title
Education (Begin with baccalaureate or other initial professional education and include postdoctoral training)
Institution and Location
Degree
Year Conferred
Field of Study
Research and Professional Experience:
Concluding with present position, list, in chronological order, previous employment, experience, and honors.
List in chronological order, the titles, all authors, and complete references to all publications during the past three years and
earlier publications pertinent to this application. If the list of publications in the last three years exceeds two pages, select the
most pertinent publications. Use at least 10-point type. DO NOT EXCEED TWO PAGES.
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