APLASTIC ANEMIA & MDS INTERNATIONAL FOUNDATION, INC.
Providing Global Support, Education & Research
P.O. BOX 613 ANNAPOLIS, MARYLAND 21404-0613 U.S.A.
TEL: 410.867.0242 800.747.2820 FAX: 410.867.0240
help@aamds.org
www.aamds.org
APPLICATION FOR NEW RESEARCHER AWARD
TO BEGIN JULY 2006
GENERAL INFORMATION
The Aplastic Anemia & MDS International Foundation, Inc., seeks to promote better
understanding of acquired bone marrow failure diseases in the hope of improved therapy for its victims.
To these ends, the Foundation offers a New Researcher Award to qualified individuals who wish to pursue
research related to acquired bone marrow failure diseases, specifically aplastic anemia, myelodysplastic
syndromes and paroxysmal nocturnal hemoglobinuria.
Applicants must have a M.D., Ph.D., or equivalent degree and must conduct their proposed
research under a sponsor who holds a formal appointment at the sponsoring institution. There are no
nationality restrictions, and the work may be carried out in the USA or abroad. However, the research
must not be carried out at a private sector, for profit laboratory.
The Award stipend is $60,000 for two-years ($30,000 a year).The second year of support is
contingent upon acceptance of a satisfactory progress report by the AAMDSIF Scientific Review Board.
An institutional overhead (included in the $60,000) of $3,000 is the maximum allowable. NRA recipients
who reapply for an additional two-year award will be judged in competition with all other applicants.
Interested parties are invited to complete and return applications no later than November 30, 2005.
Applicants should include a stamped, self-addressed postcard for acknowledgement of receipt of the grant
application. Applications will be reviewed and notification of results will be sent to each applicant after
March 2006. The Award will be activated July 2006.
Payment of the Award monies will be made quarterly to the appropriate individual at his or her
institution. The institution shall acknowledge that it holds the monies in trust for the purposes of the grant
and not as the owner of the monies.
Applicants must be willing to devote the greater portion of their total effort to research closely
related to a bone marrow failure disease, under the direction of a sponsor with a research program closely
related to bone marrow failure diseases. Relatedness is interpreted in a broad sense so the investigators in
such areas as biochemistry, microbiology, molecular biology, immunology, or other areas will be
acceptable if the proposed research is related in a significant way to aplastic anemia, myelodysplastic
syndromes and paroxysmal nocturnal hemoglobinuria.
All applications must detail their research support form all sources. The intent of this request is to
help determine the degree to which the applicant’s laboratory will support the proposed studies.
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RECIPIENT REQUIREMENTS
Recipients will be required to submit a final written report to the Foundation at the close of the
Award period, July 15, 2006. The report will include an outline and discussion of the work performed,
results and future plans for related research. Reprints of any publications written by the Award recipient
and relating to the work performed during the Award period must be included. Additionally, a one-page
summary of the above information must be submitted.
Recipients must cite support from the Aplastic Anemia & MDS International Foundation in any
and all published work relating to research conducted during the period of the Award.
APPLICATION FORM
One original and 5 copies of the completed application package must be submitted.
applications must be collated and stapled securely.
The Research Committee will not consider applications, which are incomplete. All applications
are to be sent to:
AA&MDSIF
5419 Deale-Churchton Road, Suite 102
Churchton, Maryland 20733
FOR MORE INFORMATION CALL
(800) 747-2820
OR
baker@aamds.org
APPLICATION DEADLINE IS NOVEMBER 30, 2005
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All
APLASTIC ANEMIA & MDS INTERNATIONAL FOUNDATION, INC.
Providing Global Support, Education & Research
P.O. BOX 613 ANNAPOLIS, MARYLAND 21404-0613 U.S.A.
TEL: 410.867.0242 800.747.2820 FAX: 410.867.0240
help@aamds.org
www.aamds.org
APPLICATION FOR NEW RESEARCHER AWARD
TO BEGIN JULY 2006
Be certain to fill out and supply all information, items I through V.
Include one original plus 5 copies of all information.
I.
APPLICANT INFORMATION
Name: _____________________________________________________________________
Title and degree(s): ___________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
Full business address: _________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
Telephone: ___________________ Fax: ____________________ Email: _________________
Birthplace: _______________________________
Citizenship: ______________________
Title of Proposed Research Study: ________________________________________________
___________________________________________________________________________
Professional societies of which the applicant is a member: ____________________________
___________________________________________________________________________
___________________________________________________________________________
Pending and current research grants, fellowships, salary awards received by the
applicant. (Please include dates, sources, and amount of support.)
Please provide, on separate pages,
a standard NIH (PHS 398) biographical sketch.
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-application continuedII.
SPONSOR INFORMATION
Name: ______________________________________________________________________
Title and degree(s): ____________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
Full business address: __________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
Telephone: ___________________________________________________________________
(Signature of sponsor): _________________________________________________________
Sponsor: Please provide, on separate pages,
a standard NIH (PHS 398) biographical sketch.
III. INSTITUTIONAL INFORMATION
Check to be drawn to the order of: ________________________________________________
Name of authorized institutional officer: ___________________________________________
Title: _______________________________________________________________________
Name of organization: __________________________________________________________
Full business address: __________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
The institution acknowledges that it holds the monies in trust for the purposes _____________
of the grant and not as the owner of the monies.
Telephone: ___________________________________________________________________
(Signature of authorized institutional officer): _______________________________________
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-application continuedIV. CERTIFICATION
I, the applicant herein named, if granted an Aplastic Anemia & MDS International
Foundation’s New Researcher Award, agree to submit a final report to the Foundation on
the work performed during the period of the Award, and to acknowledge Foundation support
in any published work deriving from this Award.
_________________________________________
(Signature of applicant)
V.
___________________________
(Date)
ADDITIONAL INFORMATION REQUIRED
Please enclose the following, each on a separate sheet of paper. Include one
original plus 5 copies.
1. Description of research project, including: title, summary, objective background
information research plan, references, and significance for bone marrow failure research.
(Not to exceed 10 single-spaced pages.)
2. Statement from applicant describing career objective and use of the Aplastic Anemia &
MDS International Foundation’s New Researcher Award, if awarded, to achieve those objectives.
(Not to exceed 1 single-spaced page.)
3. Statement from sponsor describing facilities and support available to the applicant for carrying
out his or her research project and also describing the sponsor’s plans for research training of the
applicant. (Not to exceed 2 single-spaced pages.)
4. Three letters of recommendation from persons who can provide evaluation of the applicant’s
research potential. An original, plus 5 copies of these letters must be included in the submitted
application. It is suggested that the writers of the applicant’s letters of recommendation be
advised that the letters must be mailed with the application. Letters may be placed in sealed
envelopes for forwarding.
5. Certification for protection of human subjects, precautions involving biohazards, and care and
treatment of laboratory animals, if appropriate. This must be on institution letterhead, and signed
by the appropriate person.
6. A concise title and description in lay terms of the project and its potential value in the field of
bone marrow failure research treatment. (Not to exceed
1 page.)
7. Self-addressed, stamped postcard for notification of receipt of application.
Applications must be complete, collated, and securely stapled.
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