PHS 398, fp1 (Rev. 9/04), Face Page, Form Page 1
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2021FELLOWSHIP APPLICATION( Application deadline: Monday, 10/12/20
|Candidate Name | |Gender |___Male |
|Last, First Middle Initial | | | |
| | | |___Female |
| | | | |
| | | |___Do not wish to |
| | | |provide |
|Project Title | |
|Limit to 80 characters, incl. spaces | |
|Candidate Degree(s) |Degree |Year received |
|CHECK ALL THAT APPLY Please include year degree was | | |
|awarded. PhD candidates with more than 7 yrs post- | | |
|degree and MD candidates with more than 7 yrs | | |
|post-fellowship should seek application approval by the | | |
|PBF Fellowship Program Scientific Director. | | |
| | ____ M.D. (or equivalent) | |
| | ____ Ph.D. (or equivalent) | |
| | ____ M.D., Ph.D. | |
| | ____ D.V.M. | |
| | ____ M.P.H. | |
|Candidate Current Title | | |
|Candidate Current Affiliation/Institution | | |
|Research Type |_____ Basic Science |Is this a reapplication? |____Yes |____ No |
| |_____ Clinical |Human subjects? |____Yes |____ No |
| |_____ Translational |Vertebrate animals? |____Yes |____ No |
|Candidate Email Address | |
|Candidate’s Office Telephone | |
|Candidate’s Cell Number | |
| | ____ U.S. citizen |
|Candidate Citizenship |____ Canadian citizen |
|CHECK ONLY ONE – Fellowships are restricted to citizens |____ Permanent Resident of U.S. or Canada |
|and permanent residents of the US and Canada or holders |____ Visa that spans the entire project period of the grant |
|of a Visa that spans the entire project period of the | |
|grant. | |
|Demographic Data: Please provide the demographic data | | |Do you hold a US permanent resident visa? (Yes/No) |
|requested. |Race and | | |
| |Ethnic Background | | |
| | | | |
| |Black or African-American _______ | | |
| |Hispanic or Latino ______ | | |
| |American Indian or Alaskan Native _______ | | |
| |Native Hawaiian or other US Pacific Islander _______ | | |
| |Asian _______ | | |
| |White _______ | | |
|Mentor Name | |
|(Last, First Middle Initial) | |
|Mentor Degree(s) |____ M.D. (or equivalent) |____ D.V.M. |
|Please check all that apply |____ Ph.D. (or equivalent) |____ M.P.H. |
| |____ M.D., Ph.D. | |
|Mentor Email Address | |
|Mentor Current Title | |
|Mentor Current Affiliation/Institution | |
|Sponsoring Institution | |
|Department | |
|Division | |
ABSTRACT
Describe the proposed studies briefly. Do not exceed the space provided
|Include the following sections. DO NOT ENLARGE BOX for more text space. |
| |
|Statement of the Problem. |
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|Specific Aims. |
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|Experimental Approach. |
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|Significance of the results. |
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LAY SUMMARY
|Describe the proposed studies in language understandable to non-scientists/physicians, including the relevance of this research to public health. Do not exceed|
|125 words |
TABLE OF CONTENTS
Page Numbers
Face Page 1-2
Abstract and Lay Summary 3
Table of Contents (not to exceed one page) 4
Budget Page 5
Candidate’s Statement (not to exceed one page) 6
Candidate’s Biographical Sketch (not to exceed five pages) 7-x
Primary Mentor Statement (not to exceed three pages) xx-xx
Primary Mentor Biographical Sketch (not to exceed five pages) xx-xx
Primary Mentor Training Record xx-xx
Co-Mentor(s) Statement(s) (not to exceed one page per Co-Mentor) xx-xx
Co-Mentor(s) Biosketch(es) xx-xx
Department Chair’s Letter / Institutional Commitment xx-xx
Collaborators and Consultants (not to exceed one page, plus Bios and letters) xx-xx
Resources (not to exceed two pages) xx-xx
Reapplication Information (not to exceed two pages) xx-xx
Abbreviations (not to exceed one page) xx
-------------------Sections above are not counted in the seven-page limit---------------------
RESEARCH PLAN (Limit of seven pages for A-D below)
A. Statement of Problem and Specific Aims xx-xx
B. Background and Significance xx-xx
C. Preliminary Studies xx-xx
D. Research Design and Methods xx-xx
-------------------Sections below are not counted in the seven-page limit---------------------
Human Subjects xx-xx
Vertebrate Animals xx-xx
Literature Cited (no page limit) xx-xx
Appendix (optional) xx-xx
Letters of Recommendation and Signature (this should be the last page of your pdf application file) xx
( Correct Table of Contents page numbers to correspond to your application, then delete this line.
BUDGET PAGE
This page serves to provide the fellowship funding information and does not require further completion (a budget justification or budget plan) by the applicant.
The total 2021 Parker B. Francis Fellowship Award in direct dollars is as follows:
|YEAR 1 |YEAR 2 |YEAR 3 |TOTAL |
|JULY 2021 – JUNE 2022 |JULY 2022 – JUNE 2023 |JULY 2023 – JUNE 2024 |JULY 2021 – JUNE 2024 |
|$75,000 |$75,000 |$75,000 |$225,000 |
Award funds are to be used to support salary and fringe for the PBF Fellow and for the fellow’s travel to scientific meetings. Travel allowance is up to a maximum of $2,000 per year, which must be used within the award year.
Supplies and equipment purchases are not allowed. These expenses should be supported by the mentor’s research grants. Such grants are an essential part of the application as documentation of sufficient financial support to complete the fellow’s project. Indirect costs on the PBF Fellowship are not allowed.
It is permissible to supplement the PBF stipend with funds from research grants, departmental funds or clinical income provided that clinical or other duties do not exceed 25 percent effort.
No budget justification or budget plan is required.
CANDIDATE’S STATEMENT
(one-page limit)
| |
|CANDIDATE’S BIOGRAPHICAL SKETCH |
|NAME |POSITION TITLE |
| | |
|DEGREE(S) | |
|EDUCATION/TRAINING (Begin with baccalaureate or other initial professional education, such as nursing, and include postdoctoral training.) |
|INSTITUTION AND LOCATION |DEGREE |YEAR(s) |FIELD OF STUDY |
| |(if applicable) | | |
| | | | |
| | | | |
| | | | |
| | | | |
| | | | |
A. Positions and Honors. List in chronological order previous positions, concluding with your present position. List any honors and awards, membership on local, regional, national committees, invited lectures and presentations, leadership roles including course or clinical rotation directorship, mentorship, and any other significant contributions.
Positions and Honors should include:
1. any and all committees – local, regional, national
2. invited presentations at national/international meetings
3. other contributions such as directing courses, invited participants in workshops, etc.
4. all honors and awards received: local, regional, national.
B. Publications (in chronological order). Note any publications where you are first author and note whether the publication is original research.
PLEASE LIST PUBLICATIONS BY THE FOLLOWING CATEGORIES:
1. Peer-reviewed articles published or in press (include invited reviews, editorials)
2. Book chapters
3. Manuscripts submitted but not accepted at the time of application
4. Abstracts at national meetings
C. Research Support. List selected ongoing and pending research projects (federal and non-federal support). Begin with the projects that are most relevant to the research proposed in this application. State the specific aims of the projects and your role (e.g., PI, Co-Investigator, Consultant) in the research project. (Include effort and annual direct dollar amounts for each research project.
PRIMARY MENTOR STATEMENT
PRIMARY MENTOR’S
BIOGRAPHICAL SKETCH
PRIMARY MENTOR’S TRAINING RECORD
|Training |Name | Degree(s) |Grant Awards Received |Current Position (past trainees) |
|Period |(Last, First) | |(including award year) |Source of Support (current trainees) |
| | | | | |
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CO-MENTOR(S) STATEMENT(S)
CO-MENTOR(S) BIOGRAPHICAL SKETCH(ES)
COLLABORATORS AND CONSULTANTS
RESOURCES
(two-page limit)
Specify the facilities to be used to conduct the proposed research. Indicate the performance sites and describe capacities, pertinent capabilities, relative proximity, and extent of availability to the project. Under “Other,” identify support services (e.g., machine shop, electronics shop) and specify the extent to which they will be available to the project. You may use two pages if necessary.
LABORATORY
CLINICAL
ANIMAL
COMPUTER
OFFICE
OTHER
MAJOR EQUIPMENT
List the most important equipment items already available for this project, noting the location and pertinent capabilities of each.
REAPPLICATION
(two-page limit, Arial 11-point font size, single-line spacing)
|Date of previous application: | |
ABBREVIATIONS
RESEARCH PLAN
(seven-page limit for items A-D)
A. STATEMENT OF PROBLEM AND SPECIFIC AIMS
B. BACKGROUND AND SIGNIFICANCE
C. WORK ACCOMPLISHED AND PRELIMINARY STUDIES
D. RESEARCH DESIGN AND METHODS
HUMAN SUBJECTS
VERTEBRATE ANIMALS
LITERATURE CITED
APPENDIX CONTENTS
LETTERS OF RECOMMENDATION
Letters of recommendation are provided from:
1. John K. Smith, M.D. (john.smith@u.knowledge.edu)
2.
3.
2021 SIGNATURE PAGE (due 10/12/20)
By signing this document, the sponsoring institution approves the grant proposal for the proposed research; assumes responsibility for and supervision of the research performed; agrees the prospective Fellow is qualified to conduct the project and that his or her participation is consistent with other faculty duties; and, accepts responsibility for the expenditure of Fellowship Program Award funds.
|PROJECT TITLE (Do not exceed 80 characters, including spaces and punctuation.) |
|Sponsoring Institution | |
|Department | |Division Section: | |
|Mailing Address| |Employer ID No. (EIN): | |
| | | | |
|for checks | | | |
| | |Total Budget Request, July 2021 to June 2024: $225,000 |
|Department Chair Section |Mentor Section |
|Name | |Name | |
|(Last, First, | |(Last, First, | |
|MI) | |MI) | |
|Degree(s) | |Degree(s) | |
|Title | |Title | |
|Mailing Address| |Mailing Address| |
|Email | |Email | |
|Fiscal Officer Section |Candidate Section |
|Name | |Name | |
|(Last, First, | |(Last, First, | |
|MI) | |MI) | |
|Degree(s) | |Degree(s) | |
|Title | |Title | |
|Mailing Address| |Mailing Address| |
|Email | |Email | |
|Signatures |
| |Signature |Printed Name |Date |
|Dept Chair | | | |
|Mentor | | | |
|Fiscal Officer | | | |
|Candidate | | | |
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7-page limit for sections A-D
The candidate should write a concise statement that addresses the following questions.
• How did you become involved in pulmonary, critical care, or sleep research?
• What are your specific areas of interest in lung biology and/or pulmonary, critical care and sleep?
• What are your future plans for research and overall career development?
Please limit your response to this page.
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CANDIDATE’S Biographical sketch (not to exceed five pages) should follow NIH format/guidelines except
1) the biographical sketch does not need a personal statement,
2) Additional material should be included as outlined in each section below
Please explicitly identify publications that represent peer-reviewed original research articles.
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Mentors play a critical role in the success of recipients of Parker B. Francis Fellowship. The Primary Mentor (3 page limit) should provide a statement that addresses the points below. Use the following headings:
This statement should address:
1. Candidate’s qualifications for research.
2. Candidate’s long-term career goals.
3. Training/career development plan, including a plan for transition to independence. This should be detailed and include things such as specific course work, workshops, and other plans for the candidate to obtain requisite skills and experience for success, proposed venues for presentation, and evaluation of scientific work, etc.
4. Please outline what work the Candidate will personally conduct, what work will be done by others, and how this will add to the Candidate’s training.
5. Candidate’s research time commitment. (At a minimum, 75% time must be made available for research. Describe all other duties of the candidate, including administrative, teaching and clinical.)
6. Availability of funding for the candidate’s research expenses.
7. For candidates with greater than seven years of research experience (time since finishing clinical or PhD training), include the reasons for continued training at the fellowship level.
8. Divisional and Departmental commitment to the candidate’s career development, including space, resources, and faculty position, if available. Department Chair’s letter also should address these points.
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THE PRIMARY MENTOR’S BIOGRAPHICAL SKETCH SHOULD BE INSERTED HERE (not to exceed five pages).
PRIMARY MENTOR’S biographical sketch should follow current NIH format/guidelines:
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1. List all research trainees supervised by the candidate’s primary scientific mentor for the last ten years.
2. List only trainees for whom the mentor was the primary mentor.
3. Include current trainees and those anticipated for next year.
4. Add or delete rows to the table below as required.
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The Co-Mentor(s) must provide a statement (not to exceed one page per Co-Mentor) that addresses the points below.
1. The expertise they bring to the applicant.
2. Their contribution to the career development plan.
3. How the responsibility for career development will be shared with the Mentor.
4. Any resources they are committing to the applicant.
5. Their experience as a mentor.
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CO-MENTOR(S) BIOGRAPHICAL SKETCH(ES) SHOULD BE INSERTED HERE.
Co-Mentor(s) biographical sketches should follow current NIH format/guidelines:
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INSERT DEPARTMENT CHAIR’S LETTER HERE
Department Chair’s letter should address institutional commitment to the candidate’s career development, including space, resources, and faculty position, if available.
Please note that this letter must be from the department chair (not from a division or section head).
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1. List collaborators and consultants on this page. There is no limit to the number of co-mentors or collaborators. Multiple collaborators and consultants are not required; however, if additional investigators will participate in the candidate’s training, please list them here.
2. This page should include a brief description of the current research interests of each collaborator and consultant with specific information on how they will participate in the candidate’s research and/or training. If this is not applicable, please delete these instructions and type “NOT APPLICABLE.”
3. Appropriate off-site collaborators and consultants may be included.
4. Include a biographical sketch for each collaborator and consultant following this page.
5. Each collaborator and consultant should provide a letter indicating their role in the research project and/or faculty development plan. Consultant letter should include any charge for services.
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Candidates who have previously applied for a Parker B. Francis Fellowship Award should provide a concise response to the prior scientific critique and describe how the new application differs from the earlier application.
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A listing of abbreviations will be helpful to the reviewers. Please provide a list here, if applicable (limit one page)
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What do you intend to do?
State the problem concisely and describe the specific aims of the research proposal. What is the hypothesis that will be tested? What is the experimental paradigm?
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Why is the work important?
Briefly provide the scientific background leading to the present application and its relevance to pulmonary, critical care, or sleep medicine or respiratory biology. Critically evaluate existing knowledge and identify the scientific gaps that the project is intended to fill. If the aims of the proposal are accomplished, how will this affect the scientific field? Where will these studies lead in developing a larger research program?
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What has already been done?
Provide an account of preliminary studies that are pertinent to this application. Preliminary data aids the reviewers in assessing the likelihood of the proposed project’s success.
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How are you going to do the work?
Describe the research design and methods to be used in the proposed studies. Organize this section by the specific aims of the research proposal. Include how the data will be collected and analyzed; describe potential problems or limitations. Published or commonly used methods do not need to be described in detail. This section must be written so that reviewers can evaluate the scientific questions, the experimental design, and the likelihood that the experiments will produce interpretable results. Include a tentative timetable showing how the work will be prioritized. Clearly identify collaborations with other investigators at the same or other institutions. Conclude with a paragraph indicating how this research will contribute to your career development.
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PLEASE CHECK: The Research Plan (Sections A-D) must be no longer than seven pages.
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For all research involving human subjects, a part of the review process will include careful consideration of protections from research risks. The Review Group (the PBF Scientific Council) will assess the adequacy of safeguards of the rights and welfare of research participants, and the appropriate inclusion of women, minorities, and children, based on the information in the application. Applications may be submitted with IRB protocol approvals pending. If you have approved protocols, please list the approval protocol number and approval date but please do not include copies of the protocol approvals in the application. If your application is selected for an award, you will be asked to submit certification of approval(s) which must specifically cite the PBF funded studies.
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In the Vertebrate Animals section address the three points listed below. Although no specific page limitation applies to this section of the application, be succinct. Applications may be submitted with IACUC protocol approvals pending. If you have approved protocols, please list the approval protocol number and approval date but please do not include copies of the protocol approvals in the application. If your application is selected for an award, you will be asked to submit certification of approval for all required protocols, which must specifically cite the PBF funded studies
1. Provide a description of the species and numbers of animals to be used in the proposed work.
2. Provide information on the veterinary care of the animals.
3. Describe procedures for ensuring the welfare of the animals to be used in the studies. For example, describe procedures to minimize pain, distress, and discomfort, and describe the methods for euthanasia.
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▪ No page limit.
▪ List citations by number in the order in which they appear in the text.
▪ Use the format shown below (“New England Journal of Medicine” style in EndNote and “Annals of Internal Medicine” in Reference Manager).
1. Kajikawa O, Frevert CW, Lin SM, Goodman RB, Mongovin SM, Wong V, Ballman K, Daubeuf B, Elson G, Martin TR. Gene expression of toll-like receptor-2, toll-like receptor-4 and MD2 is differentially regulated in rabbits with Escherichia coli pneumonia. Gene 2005;3:193-202.
2. Altemeier WA, Matute-Bello G, Frevert CW, Kawata Y, Kajikawa O, Martin TR, Glenny RW. Mechanical ventilation with moderate tidal volumes synergistically increases lung cytokine response to systemic endotoxin. Am J Physiol Lung Cell Mol Physiol 2004;164:1949-1958.
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Appendix materials are limited to:
• enlarged photographs of color images that are included in the Research Plan.
Do not place essential material such as preliminary data, experiment plans or timeline in an appendix to circumvent the page limit.
← Provide a list of your Appendix contents on this page.
← The contents should follow on the subsequent pages.
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(Letters are to be received by the application deadline, Monday, October 12, 2020.
COMPLETED SIGNATURE PAGE TO FOLLOW.
Letters of recommendation are important in the evaluation of your application.
We require three letters of recommendation. Letters of recommendation should be from the three people who can best speak to the applicant’s research and future career potential.
Letters of recommendation are to be confidential, on letterhead with signature.
The letters of recommendation should be submitted by email to Laurie.St.Gelais@ by the letter writer.
List the individuals writing letters of recommendation here.
Please include an e-mail address for each individual.
NOTE: Letters from previous postdoctoral mentors are encouraged.
Address letters to Polly E. Parsons, MD / Scientific Director, PBF Fellowship Program
The letters should cover:
• demonstrated potential for establishing an independent pulmonary research career
• evidence of originality
• adequacy of scientific background and evidence of superior performance
• quality of research publications
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