Office Use only



MITO FOUNDATION BOOSTER GRANTSThe 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 Booster Grants support highly ranked but unfunded research applications to the National Health and Medical Research Council (NHMRC). This Booster Grant Round is accepting NHMRC applications in the Ideas Grant Round which closed 17 June 2020.Mito Foundation Booster Grants are charitable grants of up to $75,000, offered to researchers to assist with their work on mitochondrial disorders.Applications will be evaluated by the Mito Foundation Grant Application Review Panel based on the following conditions. If the panel approves of the research, the application will be forwarded to the Mito Foundation Board for final approval.APPLICATION ELIGIBILITYResearch must be focused on primary mitochondrial disease.All application information must be submitted (see Supporting Documentation section below).NMHRC application received a score of at least 5 (i.e. category 5 or higher). NMHRC application CIA must have a position at an Australian institute.APPLICATION REVIEW CRITERIAImpact and benefit to the mitochondrial disease community.Contribution to diagnosis, treatment and prevention of mitochondrial disease.The NHMRC score.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.RESEARCH INSTITUTION NAMEClick or tap here to enter text.RESEARCH INSTITUTION ABN NUMBERClick or tap here to enter text.APPLICATION DATEClick or tap to enter a date.MITO FOUNDATION BOOSTER GRANT DETAILSPROJECT TITLEClick or tap here to enter text.EXPECTED PROJECT START DATEClick or tap here to enter text.EXPECTED PROJECT COMPLETION DATEClick or tap here to enter text.GRANT AMOUNT REQUESTEDClick or tap here to enter text.CURRENT FINANCIAL ASSISTANCEPlease give details of any other grants or financial assistance related to this project that you are currently receiving or have an application in progress for. Please also state how you would leverage these funds.Click 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 Grant Application Review Panel.Include the following:Aims and purpose of your project.An explanation of your project’s relevance to mitochondrial disease.The impact your project will make on the mitochondrial disease community.*maximum 1,000 words (copy + paste enabled)Click or tap here to enter text.PROJECT PLANProvide your original research plan and indicate which elements of it would be the main focus should the booster grant be awarded. Please use GANTT charts, work breakdown structure, tables, timelines etc. in addition to narrative as needed.*maximum 1,000 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.BUDGET SUMMARYProvide an explanation of how funds from this grant will be put to use. A description should be given as to how Mito Foundation funds will assist the overall project that was described in the NHMRC application.*maximum 750 words (copy + paste enabled)Click or tap here to enter text.SUPPORTING DOCUMENTATIONEnsure the following documents are submitted with this completed application:Application Grant Proposal (i.e. final RGMS Snapshot).Application Assessor document (i.e. final RGMS Snapshot).Application Assessment Summary from NHMRC.Application Final Result from NHMRC.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