SNOWDOME FUNDING



# (internal use only)Details of applicant:Name:Current Institution:Email:Telephone:Proposed Institution:Proposed start date:Proposed finish date:Australian permanent resident?If no to above, are visa requirements for Australia met?Details of supervisor/mentor:Name:Title and position:Email:Telephone:Is the position confirmed, conditional or potential:Title of proposed project:Lay summary (max. 200 words):Project Endpoints/Objectives:Objectives:Aim 1: Aim 2: Aim 3: Project outline and description (max. 1000 words)Include:Background /rationaleMethodologiesAnalysisIf clinical trials are part of the proposal provide methodology of:DesignPopulation for studyInterventionNo. of participantsNo. of sitesApprox. length studyBackground/ Rationale (300 words):Methodology plan (300 words):Feasibility (200 words): Impact (200 words):References (Max 25, Short citation format. First author, Title, Journal, Publication year):Est. total budget:Study Total: $Budget requested from Snowdome/Maddie’s Vision, and brief (50 words for each item) justification:DescriptionUnit CostMultipleTotalTOTAL$Any other funding for this project? Please indicate if current or pending.Proposed recognition of support from Snowdome/Maddie’s Vision (max 100 words):Proposed dissemination of fellowship findings to community and scientific groups (max 100 words)Project outcome parameters, time frame and milestones: **essential as payments will depend upon achievement proposed milestones** Career aspirations (max. 100 words)Other relevant information (max. 100 words)Please attach CV (2 pages) in a form compliant with application instructions. ................
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