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JUNIO R GRANT APPL ICATION
INTERNAT IONAL MYELOMA FOUNDAT ION
2001 BRIAN D. NOVIS RESEARCH A WARD
Provided by donations from p rivate individuals
The International Myeloma Foundation funds several research grants including the
Brian D . Novis Research Aw ard. These grants are provided through donations from
private individuals, and are presented annually by the International Myeloma
Foundation. These awards go to a doctor/researcher doing wo rk in the field of
mu ltip le mye loma . This year's awards will be in the amoun t of $40,000. The Brian D .
Nov is Aw ard honors the IMF 's founder Brian Nov is, who d ied of mu ltip le mye loma in
July of 1992. The International Myeloma Foundation is a non-profit organization who se
m ission is to improve the quality of life for mye loma patients wh ile wo rking toward
prevention and a cure.
QUAL IFICAT IONS
The qualifications for a candidate for the Brian D . Novis Research Aw ard include the
follow ing:
· Co mp leted post doctoral studies or clinical fellow ships not later than Augu st 1 of the
app lication year.
· Ab ility to devote a m inimum o f 70% o f his or her time to research during the Aw ard
year.
· Ab ility to provide a comp leted application w ith evidence of a meritorious research
project.
· Must complete and return application package to the IMF no later than
Augu st 31, 1999.
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APPLICATION AND SELECTION
A comp lete application should be subm itted to the IMF d irectly by the candidate and
include the follow ing:
1. an official application provided by the IMF .
2. a Cu rriculum v itae including bibliography.
3. a one page abstract of the proposed research along w ith a one page list of relevant
literature citations.
4. a four page summ ary of the research project outlining: 1.) specific aim s, 2.)
methods, novelty and significance, 3.) facilities available, 4.) previous experience of the
researcher and prelim inary wo rk accomp lished , if app licable. Any institutional
clearances required to conduct the research should be appended to this section.
Institutional overhead mu st not exceed 10% o f the grant award .
5. a statement giving details on any other funding for the research.
6. letter of recomm endation.
·Reco mm endation by a department head/ mentor or senior advisor at your
institution, critically evaluating the merits of the proposed research and the candidates
qualification and ab ility to conduct the research.
·If nom inee is not affiliated w ith the academ ic institution that w ill be the site of
the proposed research, a letter from a department chairperson or dean verifying the
candidate's affiliation w ith the institution and availability of additional resources for the
research.
7. the nom inee mu st clearly and explicitly outline the details of the facility to be used,
exact space and equipment requirements and if necessary provide letters of support or
comm itment from collaborators needed to comp lete the proposed project.
Selection of the awardee w ill be made by the IMF Scientific Advisors. No tification of
the Aw ard recipient w ill be made v ia telephone. A con firmation of acceptance should
be provided w ith in 24 hours of notification. To obtain an application please fax your
request to (818) 487-7454.
FOR MAT
App lication materials mu st be subm itted in the order listed in the App lication section.
Pages should be numbered and sub m itted in page order, beginning w ith Page 1 of the
O fficial App lication Form . Applications mu st be printed or typed on one side only of
each page. Page lengths are based on standard one-inch margins, single-spaced, w ith a
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type size no sma ller than 10 points in a standard font. Any tables, diagram s, or
pho tographs mu st by included w ith in the page lim it, and cop ies mu st be enclosed by
the applicant. No un solicited documentation or additional letters of recomm endation
w ill be considered. Any proposals arranged to comp ly w ith other funding entities'
gu idelines mu st be redone to meet the specification outlined herein.
DEL IVERY GU IDELINES
App lications may be de livered to the IMF by U .S. ma il, express delivery, or courier. No
part of the application may be sub m itted by facsim ile transm ission (FAX ). To ensure
delivery, candidates may w ish to send applications via a method requiring signature
(i.e. Federal Express or registered ma il, return receipt requested) or provide a self-
addressed, stamped postcard in the subm itted app lication package for
acknow ledgment of receipt by the IMF .
DEADL INE/SUBM ISSION ADDRESS
Co mp lete applications mu st be received in the IMF o ffice by 5 p.m . on Augu st 31, 2000.
No extensions. Send comp lete application package to:
International Myeloma Foundation
12650 Riverside Drive, Suite 206
No rth Ho llywood , CA. 91607
Phone: (818) 487-7455
Fax: (818) 487-7454
EMail: TheIMF@myeloma.org
SELECTION
The selection of the awardee w ill be made by the Scientific Adv isory Board of the IMF ,
consisting of experts in the field of mu ltip le mye loma . Candidates are strictly
prohibited from contacting members of the Award Committee about the status of their
app lication; any violation of the regulation w ill lead to the automatic disqualification of
the application.
Selection and Considerations
The Aw ard Co mm ittee w ill consider mo st favorably those proposal that provide
evidence of an applicant's research initiative and creativity independent of
mentors. The Comm ittee w ill also we igh the previous accomp lishments of the
app licant, the probability of mean ingful results from the proposed research, and
the likely contribution of the research to the advancement of our know ledge of
mye loma etiology, diagnosis, treatment, or prevention.
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Selection No tification
A ll candidates w ill receive notification from the IMF o ffice of the final selection of a
w inner by the IMF staff, by telephone or other means, on the status or evaluation of
individual applications.
AWARD COND ITIONS AND REPORT ING
· The monetary Award is provided to the awardee's sponsoring institution for
the direct support of the recipient's wo rk during the Aw ard year, which will begin on
January 1, 2001. The Aw ard may be used for laboratory supplies for the research
proposed.
· A t the conclusion of the award year, the recipient is required to subm it a brief
w ritten summ ary of the research conducted as we ll as a detailed account of the use of
Aw ard funds.
· The awardee w ill be encouraged to subm it the results of the research for
presentation at a ma jor scientific meeting and/or subm it a manuscript for publication in
a ma jor scientific journal as soon as mean ingful results are obtained. If the opportunity
allow s awardees w ill be invited to participate in IMF sponsored scientific patient and
other sem inars/meetings.
· If the awardee receives a comm itment for financial support for the proposed
project from m ore than one funding entity, the applicant w ill have to inform the IMF
immediately concerning any potential conflict and in no instance can accept funding
from m ore than one entity for the same pro ject.
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__________________________________________
Applicant Name
Page 1 of______
P lease read carefully before comp leting application. Co mp lete all sections, even where
requested responses duplicate other parts of the application. A pho tocopy of this form
may be used , but original signature mu st be provided on the top copy.
APPL ICANT
NAM E_________________________________________________________________
Last
F irst
M iddle Initial
PRESE NT T ITLE________________________________________________________
INSTITUTION__________________________________________________________
MA ILING ADDRE SS____________________________________________________
________________________________________________________________________
________________________________________________________________________
TELEPHONE NU MBERS (____)________________ __(_____)______________
wo rk
ho me
E-MA IL ADDRESS ______________________________________________________
TITLE OF PROPOSED RESEARCH________________________________________
________________________________________________________________________
________________________________________________________________________
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__________________________________________
(Applicant Name)
Page 2 of ___
EDUCAT ION
(Begin w ith initial professional education and include postdoctoral training)
INSTITUTION/LOCATION DEGREE YEAR CONFERRED
FIELD OF STUDY
______________________________________________________________________________________
______________________________________________________________________________________
______________________________________________________________________________________
______________________________________________________________________________________
* Attach required information for degrees other than doctorates provided at U.S. universities.
RESEARCH AND/OR PROFESS IONAL EXPER IENCE
List in chronological order previous employment, experience, and honors, highlighting previous research experience, concluding
with present position. If additional space is needed please attach a separate sheet.
______________________________________________________________________________________
______________________________________________________________________________________
______________________________________________________________________________________
______________________________________________________________________________________
MEMBERSH IPS IN PROFESS IONAL ORGAN IZATIONS
List present membership in any local and national/international professional and voluntary organizations
______________________________________________________________________________________
______________________________________________________________________________________
______________________________________________________________________________________
RESEARCH SUPPORT
List research funding current /pending, and the name of the source
______________________________________________________________________________________
______________________________________________________________________________________
______________________________________________________________________________________
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CERT IFICAT ION
I certify that, to the best of my know ledge, all of the information contained in this
app lication form is true and the research as proposed to be conducted by the applicant
wou ld comp ly w ith all of the standards of the sponsoring institution.
APPL ICANT____________________________________________________________
Signature
Da te
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INTERNAT IONAL MYELOMA FOUNDAT ION
BR IAN D . NOVIS RESEARCH A WARD
Provided by donations from p rivate individuals
App lication Check list
For each of the six comp lete copies (one original, five photocopies) of the
app lication required to be provided, use the follow ing checklist to ensure all required
materials are subm itted in this order.
___ 1. Curriculum v itae, including a comp lete bibliography.
___ 2. One-page abstract of the proposed research.
___ 3. Five-page proposal of the research project in single-spaced form ,
addressing
all of the follow ing related aspects, in this order:
___ a. specific aim s, methods, novelty, and sign ificance;
___ b. facilities and resources available for this research;
___ c. previous experience of the applicant that relates to this proposal;
___ d. prelim inary wo rk accomp lished (if the proposal seeks to build on
previous results or expand upon an ex isting research project); and
___ e. one-page list of relevant citations from pub lished literature supporting
the statements in the proposal (including any relevant
pub lications by the
app licant).
___ 4. Proof of satisfaction of any institutional clearances required by the sponsoring
institution, such as approval to conduct research on human subjects, comp liance w ith
standards in anima l experimentation, or
approval for wo rk w ith genetic material.
___ 5. Letter of recomm endation from the dean, departmental chairperson, or
other
institutional official.
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SENIOR G RA NT APPLICATION
INTERNATIONAL MYELOMA FOUNDA TIO N
2001 BRIAN D. NOVIS RESEARCH AWA RD
Provided by donations from private individuals
The International Myelom a Foundation funds several research grants including the
Brian D. Novis Research Award. These grants are provided through donations from
private individuals, and are presented annually by the International My elom a
Foundation. These awards go to a doctor/researcher doing work in the field of
multiple myeloma. The Brian D. Novis Awa rd honors the IMF's founde r Brian Novis,
wh o died of multiple my elom a in July of 1992. The International Myeloma Foundation
is a non-profit organization whose mission is to improve the quality of life for myeloma
patients while working toward prevention and a cure.
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International Myelom a Foundation
2001 Senior Research Award
Application Instructions
A.
General
a.
Relevance: Proposed early-stage clinical research in multiple myeloma,
which is intended to develop innovative approaches to treatment,
diagnosis or prevention.
b.
Signatures: All applications must be signed by the applicant, individua l
authorized to sign for institution and fiscal officer.
c.
Required Format: Applications must be typed in English on 8 1/2 x 11
inch white paper, using single-spaced text, one-inc h margins, using either
10 pt. font Courier or 12 pt. font Arial or 12 pt. font Times New Roman.
Type Applicant's name in the upper right corner of each page.
Ap plication forms can be photocopied. Page limitations must be observed
for each section as described below. Ten copies must be provided.
B.
Biographical Sketch
This section should contain the biographical sketches of all key personn el in NIH
format. Do not exceed two pages per biographical sketch.
C.
Budget
Please provide a detailed budget fully outlining specific needs for professional and
technical staff. Itemize supplies by category. Identify each item of equipment with an
acquisition cost of more than $500.00. No more than $750 may be requested for travel
category. If patient care costs are requested, include under Other Costs.
All budget items should be explained under Budge t Justification.
D.
Other Research Support
Other support is defined as any specific funds or resources, whether Federal, non-
Federal or institutional, available to the principal investigator (and other key personnel
name d in the application ) in direct support of their research endeavors.
Information regarding active or pending sources of support available to the principal
investigator (and other key personnel named in the app lication), whether related to this
application or not, is an important part of the review and award process and must be
included.
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E.
Project Description
Limited to 10 pages, excluding references, figures, and tables. The project description
should be presented in the following sequence:
a.)
Specific Aims (approximately 0.5 page)
b.)
Scientific Background and Clinical Significance of Proposed
Work (approximately 1.5 pages)
c.)
Previous Work/Preliminary Data (approximately 1.0 page)
d.)
Methods (approximately 2.0 pages)
e.)
Plans for Clinical Application of the Data (approximately 0.5
page)
f.)
Plans for Investigator Interaction (approxima tely 0.5 page)
Clinical research protocols, if part of the application, should be submitted as Appen dix
material to Section E. Include IRB Approval date (if protocol has been approved), and
IRB Comp liance num ber. Label first page of Project Description as pag e 6.
F.
Laboratory Animals Statement
For projects which involve laboratory animals, the Institutional Animal Care and Use
Commi ttee (IACU C) Approval Date and Animal Welfare Assurance numbe r must be
given.
G.
Biohazards Statement
An institutional statement and assurances regarding potential biohazards and
safeguards must be included.
H.
Publications
Four sets of the applicant's publications, which are relevant to the proposed project,
should be included. Attach one set to the original application, and one set to each of the
first three copies of the application.
I.
Complete Application
Send the original and nine (9) double-sided copies to:
International Myelom a Foundation
12650 Riverside Drive, Suite 206
North Hollywood, CA. 91607
Phone: (818) 487-7455
Fax: (818) 487-7454
EM ail: TheIMF@my elom a.org
Applications must be received by 5:00 P.M., August 31, 1999. Applications received
after this date or incomplete applications will not be considered.
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International Myelom a Foundation
2001 Senior Research Award
Application Form
1. Project Title:_________________________________________________________
2. Applicant:____________________________ Degrees:______________________
Institution:________________________________________________________
Department:____________________________________________________ _ _
Address:____________________________________________ _____________
City:_____________________________________________________________
State: _________________________________Zip:___________________ ____
Country:__________________________________________________________
Fax: _______________________________E-Mail:________________________
3. Total Amount Requested: Yea r 1:______________
4. We, the undersigned, have reviewed this application for a International Myeloma
Foundation Award and are familiar with the policies, terms, and conditions of the
IMF concerning this research support and do hereby accept the obligation to
comply with all such policies, terms and conditions.
Please type the follow ing:
______________________________________________________
5. Applicant
Signature
Date
______________________________________________________
6. Individual Authorized to
Signature
Date
Sign for Institution
______________________________________________________
7. Fiscal Officer
Signature
Date
8. Address of Fiscal Officer:
_______________________________
_______________________________
_______________________________
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Ap plicant's Nam e:_______________________ ______________
Abstract-Scientific: Briefly describe your proposed project in 100 words or less using
technical language.
Abstract-Lay: Briefly describe your proposed project in 100 words or less using non-
technical language.
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Ap plicant's Nam e:________________________________________________
Biographical Sketch: Please provide the biographical sketches of all key personnel in
NIH format. Do not exceed two pages per biographical sketch.
6
Ap plicant's Nam e:________________________________________________
BUDGE T
Budget Category
FIRST YEAR
1. PERSONNE L:
NAM E
ROL E
%EFFOR T
TOTA L
PERSONNE L:
2. SUPPLIES : (Itemize by Category)
TOTA L
SUPPLIES :
3. EQUIPMEN T: (Itemize)
TOTA L
EQUIPMEN T:
4. OTHE R EXPENSES: (Itemize by Category)
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TOTA L OTHER EXP ENSES :
5. TRAVE L
6. TOTA L DIRECT CO STS (1+2+3+4+5)
7. INDIRECT COSTS ( Maximum 8% of 6)
8. TOTA L COSTS (6+7)
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Ap plicant's Nam e:________________________________________________
Budget Justification:
Please provide a justification for each item in budget.
Use continuation sheets as
needed and number 4a, 4b, 4c, etc.
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Ap plicant's Nam e:_________________________________________________
Other Research Support:
List all active and pending research support for applicant and for all key personnel
name d in the application. Include all support available for the proposed work during
the project period.
For each item, please give the source of support, identifying
numbe r, project title, nam e of principal investigator/program director, annual direct
costs, and total period of support. Use continuation sheets as necessary and numbe r 5a,
5b, 5c, etc.
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International Myeloma Foundation
2000 Senior Research Awar d
Application Check List
BEFORE MAILING , ALL APPLICANTS SH OULD CHECK THEIR SUBMISSION FOR
TH E FOLL OWING :
___Cover page completed with all administrative signatures.
___Page 1 completed - Abstracts (Scientific and Lay); Research Relevance.
___Page 2 completed - Biographical sketch for all ke y personnel.
___Page 3 completed - Budget.
___Page 4 completed - Budget justification.
___Page 5 completed - Research support (active and pending).
___Project Description (limited to ten (10) pages, not including references.
___Appendix (Clinical protocols, if applicable).
___Laboratory Animals Statement.
___Biohazards Statement.
___Four (4) sets of applicant's publications (if applicable).
___Each page must contain the applicant's full name in the top, right-hand
corner.
___Applications subm itted in English, single-space d text, one-inch margins, and typed
in either 10 pt. font Arial, 10 pt. font Courier or 12 pt. font Arial or 12 pt. font Times
New Roman .
___If you wish to be notified of receipt of application, send a self-addressed stamped
postcard
marked
"Receipt
of
application
material
by
International
Myeloma
Foundation:______________(Date)."
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