Preliminary Proposal Application Form
Millennium Science Nuclei Competition - 2010
ITEM 1
PRINCIPAL INVESTIGATOR’S INFORMATION
(Please fill in empty spaces)
1. Name of the Nucleus ______________________________________________________
2. Area or Discipline (Identify area/s or discipline/s to which the Nucleus project proposal
is aimed at)
3. Nucleus’ Principal Investigator:
3.1. Name and identification
_________________________________________________________________________
Father’s name (CAPITAL)
Mother’s name
________________________
____________________
______________
RUT or Passport Number
Birth date (day/month/year)
Nationality
Names
3.2. Primary affiliation
_________________________
Position
______________________________________________________________________
Institution, faculty, department, city, country
3.3. Street Address (at work site):
_________________________________________________________________________
3.4. Mailing Address (if different from street address):
_________________________________________________________________________
3.5. Telephone
3.6. Alternative telephone
______________________________________________________________________
Country Code
City Code
Number
Country Code
City Code
Number
3.7. Fax
3.8. Electronic Mail
_____________________________________________________________________
Country Code
City Code
Number
3.9. Web site of the Principal Investigator
______________________________________________________________________
4. Signature of the Nucleus Principal Investigator or legal entity
I hereby declare that the facts described in this application form are true, and I agree to accept responsibility to conduct
and execute the project both in the scientific technical and administrative scopes, as well as to comply with environmental
and human research subjects protection regulations, and as applicable, responsibility for human care and use of laboratory
animals and laboratory safety. If a grant is awarded as a result of this application I will provide all required progress
reports. I certify that I am a Chilean or foreign citizen resident in Chile.
__________________________
Signature
____________________
Date
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Preliminary Proposal Application Form
Millennium Science Nuclei Competition - 2010
ITEM 2
HOST INSTITUTION
(In case of more than one Host Institution, fill in one form for each one)
1. Principal Investigator’s name:
2. Nucleus’ Name:
3. Host Institution’s name:
4. Legal status (indicate Decree Nbr.):
5. Division linked to the project:
______________________________________________________________________
(University, Faculty, Department, Division or other)
______________________________________________________________________
5. Authority from the Host Institution
Name and signature of one authority from the Host Institution (Department Director, Dean,
Director of Research, Institute’s Director, Rector or other).
a) Name
:
b) Position :
c) Mailing Address
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
d) Telephone
______________________________________________________________________
Country Code
City Code / Area Code
Number
e) Fax
______________________________________________________________________
Country Code
City Code / Area Code
Number
f) E-mail address
______________________________________________________________________
Signature: _________________________________Date: __________________________
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Preliminary Proposal Application Form
Millennium Science Nuclei Competition - 2010
ITEM 3
SUMMARY OF THE PROPOSAL
1. Principal Investigator’s Name:
2. Nucleus’ name:
3. Proposal: 2 to 5 pages.
Explain, in a brief description (2 to 5 pages), your idea about the Millennium Science
Nucleus you would like to create. Your writing should include, with no exclusion,
statements about the following elements, with no exclusion:
-
Your research team: previous achievements, individually and as a group.
-
Accomplishments you hope to obtain in the short and long term including the
formation of young scientists, the impact you would expect form the Nucleus in
your specialty area, in the country and in an even wider field.
-
Your outreach plans (e.g. summer-winter schools, lecture programs for elementary
and secondary schools, relationships with the industry and other sectors) and plans
of network collaboration and interaction with other institutions or peer laboratories.
-
Procedures you will use in order to accomplish your goals.
Please particularly consider the Program Committee (PC) needs to know quite precisely
what you propose to do to solve the identified scientific problem. If the research is
described in very general terms, the PC will not be able to judge its scientific merit.
Enough technical detail must be given to allow an expert in this field to asses the possibility
of success.
You are also invited to describe precisely: What will you perform jointly? What
mechanisms will you use to assure that your research is interactive and that the people who
are being trained will benefit from the diverse expertise? How allotting funds to you as a
Nucleus add value in comparison to receiving individual research grant?
This current guide intends to be open-ended in order to give you the chance of expressing a
non-restrictive vision about your Millennium Science Nucleus proposal.
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Preliminary Proposal Application Form
Millennium Science Nuclei Competition - 2010
ITEM 4
SCIENTIFIC STAFF
Present a list of the names and current occupations of the Principal Investigator, and the
other Associated Investigators of the scientific staff, as well as of senior researchers could
participate supporting the project.
1. Associated Scientific Staff: Fill in the next page’s first table (table A). Make sure that
the names listed here are not simultaneously listed in another application for a different
Nucleus or Institute. Print first the name of the Principal Investigator, followed by the
Deputy Principal Investigator, and after, those of the other Associated Researchers of the
Nucleus. Specify the Identification Number (RUT or passport), Position, and Institution
holding this position.
2. Senior Scientific Staff: Fill in the next page’s second table (table B). Specify the
Identification Number (RUT or passport), Position and Institution holding this position.
3. Curricula vitae + publications list: (max. 5 pages): Enclose the curricula of the
Associated Researchers including the Principal Investigator proposed for the Nucleus, and a
publication list for the Principal Investigator and each associated scientific member, and the
experience in training of students and doctors.
Do not include curricula for senior staff.
Every CV must follow the included form, and not exceed two letter size pages. Besides,
you should include a complete list of his/her most relevant publications in media with
Editorial Committee, in a space not exceeding three letter size pages, highlighting the five
most relevant ones.
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Preliminary Proposal Application Form
Millennium Science Nuclei Competition - 2010
SCIENTIFIC STAFF
1 . Identification of the Scientific Staff (Principal Investigator, Deputy Principal
Investigator, and other Associated Scientist)
Table A
Name (Father’s name, Mother’s
name, Names)
Identification
(RUT/Passport)
Position
Affiliation
Position
Affiliation
Principal Investigator
Deputy Principal Investigator
Associated Researchers
2 . Identification of the Senior Staff
Table B
Name (Father’s name, Mother’s
name, Names)
Identification
(RUT/Passport)
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Preliminary Proposal Application Form
Millennium Science Nuclei Competition - 2010
SCIENTIFIC STAFF
CURRICULA VITAE / LIST OF PUBLICATIONS
For each Associated Scientist, including the Principal Investigator, complete all sections of
the included form, following the instructions described for this item.
Do not include curricula vitae of senior staff, adjunct scientists, or other researchers.
CURRICULUM VITAE ________ INVESTIGATOR (Principal or Associated) (2 pages maximum)
PERSONAL DATA
Father’s name
Birth date
Mother’s name
Age (to 28/May/2010)
Title
Current position
Names
Identification number
Gender (M o F)
Nationality
Academic Degree
Institution (Department, Faculty, Institution)
Street Address (street, N°, locality, postal code, city, country)
Mailing Address (if different from street address)
Telephone (w/codes)
Fax (w/codes)
Electronic address
Web Site
ACADEMIC AND PROFESSIONAL EXPERIENCE, including experience in students and
doctoral training
MAIN PUBLICATIONS IN MEDIA WITH EDITORIAL COMMITTEE, highlighting 5 most
relevant ones (3 pages maximum)
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