Application Form - The Skin Cancer Foundation

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2016 RESEARCH GRANT AWARDS PROGRAM
OF THE SKIN CANCER FOUNDATION
The Skin Cancer Foundation is now accepting applications for support of pilot
research projects related to skin cancer. The Foundation funds basic research and
clinical studies which address improved methods of prevention, detection, and
treatment of skin cancer. Researchers are invited to submit applications for one-year
projects to be conducted within the Dermatology departments of medical institutions
within the U.S.
Since it’s founding in 1979, The Skin Cancer Foundation has set the standard for
educating the public and the medical profession about skin cancer, its prevention by
means of sun protection, and the need for early detection and prompt, effective
treatment. It is the only international organization devoted solely to combating the
world’s most common cancer. The Foundation’s mission is to decrease the incidence
of the disease by means of public and professional education, and research.
APPLICATION REQUIREMENTS
The deadline for applications is Friday, October 16, 2015.
Applications must be received by this date to be considered.
The completed application form (and all supporting documentation) should be
sent electronically to jperrino@skincancer.org. Files should be uploaded as a
PDF and no larger than 10 mb.
Only applications for research projects relevant to skin cancer will be accepted for
consideration. The Foundation's Research Grant Awards Program is intended for
pilot projects, which, if successful, can be developed to the point where they are
eligible for larger grants from other sources. Research must be conducted by
dermatology residents, fellows, and young faculty (5-10 years post first
academic appointment) from institutions within the U.S. Preference is given to
projects that address, at the basic science and clinical level, improved methods of
prevention, detection, and treatment of skin cancers.
The Foundation is pleased to increase its pledge for the research program for 2016.
Levels of funding for research grants are:
(1) - $10,000
(1) - $15,000
(3) - $25,000
Funding is based on the scope of the research project. Please specify the grant
amount for which you are applying on page 4 under “Budget”. It is the Foundation's
policy not to fund overhead or indirect costs.
Grant recipients will be notified in December, 2015. Presentations will take place at
the Foundation's Grant Awards Reception on Sunday, March 6, 2016, held
concurrent with the Annual Meeting of The American Academy of Dermatology, in
Washington DC. Grantees must be present at the reception to accept their
awards in person.
RESEARCH GRANT APPLICATION - 2016
NAME & TITLE OF PRINCIPAL INVESTIGATOR:
MAILING ADDRESS:
List your names and address completely so that your notification letter will reach you.
CONTACT INFORMATION
Phone: ______________________
Fax:_________________________
E-mail:_______________________
INSTITUTION CONDUCTING PROJECT:
ADDRESS:
DEPARTMENT / DIVISION UNDER WHICH PROJECT WILL BE CONDUCTED:
DEPARTMENT CHAIRMAN & TITLE:
NAME & TITLE OF RESPONSIBLE ADMINISTRATOR:
PHONE:
TITLE OF PROJECT TO BE SUPPORTED:
DATE PROJECT TO BE INITIATED:
2
BRIEF SUMMARY OF PROJECT (50 WORDS OR LESS)
PROJECT DESCRIPTION
In no more than 5 or 6 typewritten pages, please provide the following information:
1.
2.
3.
4.
5.
Purpose and/or objectives.
Current status of work in this area
Methods or procedures to be adopted
Facilities available (including equipment)
List of personnel who will conduct this project
APPEND TO APPLICATION
1. Curriculum Vita of Principal Investigator (including description of current and past work.)
2. Curricula Vitae of other professional staff who will conduct this program.
3
FINANCING (Funding will be for a maximum of one year.)
`
1. List other sources and amounts of support for this project:
1. *BUDGET: Check one:
$25,000
$15,000
$10,000
A. PERSONNEL COSTS:
NAME & TITLE
%TIME
SALARY
TOTAL $
B. EQUIPMENT:
TOTAL $
C. SUPPLIES:
TOTAL $
TOTAL BUDGET FOR THE YEAR $
*Institutions are asked to waive overhead costs.
To my knowledge, the information contained in this application is true.
If The Skin Cancer Foundation funds this project, I agree to acknowledge the Foundation
in all relevant publications and provide a six-month progress report and a final report at
the end of the term of funding.
SIGNATURE OF PRINCIPAL INVESTIGATOR
DATE
4
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