Continuation Grant Application Cover Sheet
Complete and print this form and submit original copy along with PDF copy on a USB flash drive.
APPLICANT
LAST NAME:
DEGREE(S):
FIRST NAME:
MI:
ACADEMIC TITLE:
ADDRESS:
GENDER:
DATE OF APPOINTMENT (REQ.):
INSTITUTION:
TELEPHONE:
DEPARTMENT(S):
SIGNATURE:
E-MAIL:
MENTOR
LAST NAME:
DEGREE(S):
FIRST NAME:
MI:
ADDRESS:
GENDER:
ACADEMIC TITLE:
DATE OF APPOINTMENT:
INSTITUTION:
TELEPHONE:
DEPARTMENT(S):
SIGNATURE:
E-MAIL:
CLINICAL RESEARCH PROPOSAL
CLINICAL RESEARCH AREA [refer to the following ‘Area of Study’
TITLE:
list, select one option]:
HUMAN SUBJECTS:
Y
VERTEBRATE ANIMALS:
N | BIOHAZARDS:
Y
Y
N
TYPE(S) OF CANCER [refer to the following ‘Type of Cancer’ list for
option(s)]:
N
APPROVED BY EXECUTIVE OFFICER
NAME:
GENDER:
TITLE:
INSTITUTION:
TELEPHONE:
E-MAIL:
ADDRESS:
SIGNATURE:
FISCAL OFFICER
NAME:
TITLE:
GENDER:
INSTITUTION:
TELEPHONE:
E-MAIL:
ADDRESS:
SIGNATURE:
DRCRF On e E x ch ang e Plaz a, 5 5 Br oadw a y, S ui te 302, New Yo r k, NY 10006 1. 877. 7C ANCE R
Aw a r d P ro gr am s 2 12. 4 5 5. 0520 fax 917.591. 4780
ww w .d am on ru n yo n . or g
Continuation Grant Application Cover Sheet, page 2
(if applicable)
CO-MENTOR (if applicable)
LAST NAME:
DEGREE(S):
FIRST NAME:
MI:
ADDRESS:
GENDER:
ACADEMIC TITLE:
DATE OF APPOINTMENT:
INSTITUTION:
TELEPHONE:
DEPARTMENT(S):
SIGNATURE:
E-MAIL:
DRCRF On e E x ch ang e Plaz a, 5 5 Br oadw a y, S ui te 302, New Yo r k, NY 10006 1. 877. 7C ANCE R
Aw a r d P ro gr am s 2 12. 4 5 5. 0520 fax 917.591. 4780
ww w .d am on ru n yo n . or g
AREA OF STUDY
Fill in the space on the cover sheet with one of these areas, the primary focus of your research:

Aging

Medicinal Chemistry

Animal models/mouse models

Microbiology

Basic Genetics

Nanotechnology

Basic Immunology

Neuroscience

Biochemistry

Organic Chemistry

Bioinformatics

Outcomes Research

Biomedical Engineering

Pain Management/Palliative Care

Biophysics

Pathology

Cancer Genetics

Pharmacogenomics and Biomarkers

Carcinogenesis

Physical Chemistry

Cell Biology

Prevention

Cell Death

Proliferation/Cell Cycle

Chemical Biology

Protein processing

Chemoprevention

Proteomics

Chemoresistance


Chromatin Biology
RNA (RNA processing, miRNA and piRNA
mechanisms, enzymatic RNAs etc.)

Chromosome and Telomere Biology

Senescence

Computational Biology

Signal Transduction

Developmental Biology

Stem Cell Biology

Developmental Neurobiology

Structural Biology

Diagnostics

Surgical Oncology

Drug Discovery

Systems Biology

Endocrinology

Toxicology/Toxicogenomics

Epidemiology/ Population Science

Tumor Immunology

Epigenetics

Vaccine Therapy

Evolution

Vascular Biology/Angiogenesis

Experimental Therapeutics

Virology

Gene Therapy

Genomics

Imaging

Immunotherapy

Infectious Disease

Invasion and Metastasis
DRCRF On e E x ch ang e Plaz a, 5 5 Br oadw a y, S ui te 302, New Yo r k, NY 10006 1. 877. 7C ANCE R
Aw a r d P ro gr am s 2 12. 4 5 5. 0520 fax 917.591. 4780
ww w .d am on ru n yo n . or g
TYPE(S) OF CANCER
Fill in the space on the cover sheet with any that are directly related to your research:

AIDS-Related Cancers

All Cancers

Bladder

Breast

Colorectal

Esophageal

Ewing’s Tumors

Gallbladder

Gastric

Gynecological (including Cervical, Endometrial, Ovarian, Uterine, Vaginal, Vulvar)

Head and Neck

Kidney (Renal Cell)

Leukemias

Liver (including Hepatocellular, Cholangiocarcinoma, etc.)

Lung

Lymphomas

Merkel Cell

Mesothelioma

Myeloma (including Monoclonal Gammopathy of Undetermined Significance)

Nasopharyngeal

Neuroendocrine (including Carcinoid, Adrenal Pheochromocytomas, Medullary Carcinomas of the Thyroid,
Multiple Endocrine Neoplasia Syndromes, Pancreatic Endocrine Tumors, etc.)

Neuro-oncology (including Adult Brain, Pediatric Brain, Meningiomas, CNS, etc.)

Pancreatic

Prostate

Retinoblastoma

Sarcomas

Skin (Melanoma and Non-melanoma)

Testicular (including other Germ Cell Tumors)

Thyroid (including Papillary, Follicular and Anaplastic)

Wilm’s Tumor
DRCRF On e E x ch ang e Plaz a, 5 5 Br oa dw a y, S ui te 302, New Yo r k, NY 10006 1. 877. 7C ANCE R
Aw a r d P ro gr am s 2 12. 4 5 5. 05 2 0 fax 917.591. 4780
ww w .d am on ru n yo n . or g