Office Use only - Mito Foundation



MITO FOUNDATION TWO YEAR CLINICAL FELLOWSHIPSThe Mito Foundation supports mitochondrial disease patients and their families, funds essential research into the prevention, diagnosis, treatment and cures of mitochondrial disorders, and increases awareness and education about this devastating disease. Mito Foundation Clinical Fellowships assist in rapidly transforming research discoveries into clinical practice. The Fellowship aims to train Australian clinicians to provide the best possible care for Australian mitochondrial disease patients.Mito Foundation Clinical Fellowships are charitable grants of up to $125,000 per year for up to two years, offered to support a clinician’s salary during their work on mitochondrial disorders.Mito Foundation Two Year Clinical Fellowships incorporate a research project into the clinical training being undertaken. Please complete a Mito Foundation One Year Clinical Fellowship if you are not intending to include a research element during your Fellowship.Clinicians should be available to make periodic contact with Mito Foundation staff and be able to participate in fundraising and educational events as requested by the Foundation.Applications will be evaluated by the Mito Foundation Clinical and Scientific Review Panel and the Mito Foundation Strategic Alignment Review Panel based on the following conditions. If the panels approve of the research, the application will be forwarded to the Mito Foundation Board of Directors for final approval.APPLICATION ELIGIBILITYResearch must be focused on primary mitochondrial disease.All application information must be submitted.Applicant must have a position at an Australian institute.Applicant must provide letter of support from host institute.APPLICATION REVIEW CRITERIAContribution to diagnosis, treatment and prevention of mitochondrial disease, and direct patient benefit – 30%Research vision, scientific merit/innovation and achieving outcomes – 25%.Quality of research environment to perform work efficiently/accurately – 25%Track record of applicant and co-investigators – 20%APPLICANT DETAILSNAMEClick or tap here to enter text.ADDRESSClick or tap here to enter text.PHONE Click or tap here to enter text.EMAIL Click or tap here to enter text.CITIZENSHIP/RESIDENCY STATUSClick or tap here to enter text.INSTITUTION NAMEClick or tap here to enter text.INSTITUTION ABN NUMBERClick or tap here to enter text.APPLICATION DATEClick or tap to enter a date.MITO FOUNDATION CLINICAL FELLOWSHIP DETAILSFELLOWSHIP START DATEClick or tap to enter a date.EXPECTED DATE OF FELLOWSHIP COMPLETIONClick or tap to enter a date.GRANT AMOUNT REQUESTEDClick or tap here to enter text.RELEVANT FUNDINGPlease give details of any other grants or financial assistance related to this fellowship and project that you are currently receiving or have an application in progress for.*maximum 2,000 words (copy + paste enabled)Click or tap here to enter text.RESEARCH ENVIRONMENT & SUPERVISORY TEAMPlease give details of the clinical and educational environment, including what activities are available for a fellow to participate in and what clinical experience will be on offer. Please provide evidence that the host environment will be able to provide training.*maximum 500 words (copy + paste enabled)Click or tap here to enter text.BIOSKETCH FOR APPLICANT AND CO-INVESTIGATORSInclude details of current research funding and most recent and relevant publications.*maximum 3,000 words each (copy + paste enabled)Click or tap here to enter text.FELLOWSHIP PLAN, OUTPUTS AND METRICSPlease describe the fellowship plan. Please describe the outputs/outcomes/metrics of the fellowship. Please use GANTT charts, tables, timelines etc. in addition to narrative as needed.Questions to assist with your answer:What will a successful fellowship look like?? What are the clinical expectations of the fellowship? What skillsets/expertise will be employed? What writing/data collection will be done? How much clinical exposure will be involved? How many patients will be seen? What types of patients will be seen? What lab experience will be attained? Which clinics will the fellow be involved in and in what capacity? Will there be any clinical audit work involved? Will there be any clinical data collection involved? Is there a writing component of the fellowship? What research publications are expected? *maximum 3,000 words each (copy + paste enabled)Click or tap here to enter text.MITO FOUNDATION CLINICAL FELLOWSHIP PROJECT DETAILSPROJECT TITLEClick or tap here to enter text.PROJECT SUMMARYProvide an outline of your research proposal. This should be brief but include key information in a way that can be understood by the Mito Foundation Clinical and Scientific Review Panel.Include the following:Aims and purpose of your project.An explanation of your project’s relevance to mitochondrial disease.How you will undertake your project.The expected outcomes of your project.The impact your project will make on the mitochondrial disease community.The expected budget of your project.*maximum 3,000 words (copy + paste enabled)Click or tap here to enter text.LAY PROJECT SUMMARYUse simple language to indicate the purpose of the project and how it relates to mitochondrial disease and the expected outcomes. This will be used by the Mito Foundation for marketing purposes. *maximum 250 words (copy + paste enabled)Click or tap here to enter text.REFERENCE LIST*maximum 1,500 words (copy + paste enabled)Click or tap here to enter text.PLEASE SEND THIS APPLICATION AND ANY RELEVANT DOCUMENTATION TO: grants@.au. ................
................

In order to avoid copyright disputes, this page is only a partial summary.

Google Online Preview   Download