ࡱ> Y !7bjbj %ҜiҜi.Efftmmm5<q|m>h !!!!K""m" y"=======$|A2D=S#K"K"S#S#=!!H='''S#j!!='S#=''2h3!X#B2==0>3D$TD 3D3 "0""'""d"""==S&l""">S#S#S#S#D"""""""""fY : Charles H. Hood Foundation Child Health Research Awards Program Application Face Sheet Project Period: July 1, 2024 June 30, 2026 Total Award: $200,000 (over 2 yrs.), Indirects: up to $9,091/year TITLE OF PROJECT KEY WORDSAPPLICANT Name, Degree(s): _______________________________________ Academic Title: _________________________________________ Department: ___________________________________________ Institution:_____________________________________________ Address:_____________________________________________________________________________________________________ Telephone*___________________________________________ Email:_________________________________________________ *Please indicate a number where you can be reached directly.DEPARTMENT OR DIVISION CHAIR Name, Degree(s):________________________________________ Academic Title: _________________________________________ Department: ___________________________________________ Institution:_____________________________________________Address:_____________________________________________________________________________________________________ Telephone:_____________________________________________ Email:_________________________________________________AUTHORIZED INSTITUTIONAL REPRESENTATIVE Name:_________________________________________________ Title:__________________________________________________ Institution:_____________________________________________Address:_____________________________________________________________________________________________________ ______________________________________________________ Telephone:_____________________________________________Fax:___________________________________________________ Email:_________________________________________________ INSTITUTIONAL OFFICER TO RECEIVE FUNDS Name:_________________________________________________ Title: __________________________________________________ Institution:_____________________________________________Address:_____________________________________________________________________________________________________ ______________________________________________________ Telephone:_____________________________________________Fax:___________________________________________________ Email:_________________________________________________ CERTIFICATION: By signing this Face Sheet, we certify that the statements contained in this application are true and complete to the best of our knowledge, and accept the terms of the Child Health Research Awards Program as documented in the Terms of the Award. The Applicants signature also confirms responsibility for obtaining any animal use, human subjects (including informed consent, if applicable), and/or other required institutional approvals.SIGNATURE OF APPLICANT ____________________________________Date:______________SIGNATURE OF AUTHORIZED INSTITUTIONAL REPRESENTATIVE ____________________________________Date:______________ Contact: Charlene Mancusi,  HYPERLINK "mailto:Charlene.Mancusi@CharlesHoodFoundation.org" Charlene.Mancusi@CharlesHoodFoundation.org or (617) 279-2230 Table of Contents Application Face Sheet 1 Table of Contents 2 Research Project Summary and Performance Sites 3 Non-Technical Project Summary Impact Statement . Applicant Independence / Institutional Commitment Form Applicant Biosketch Current and Pending Support Form(s) Budget Forms A1 C Research Proposal Response to Previous Critique (if resubmitting) Specific Aims Background and Significance Preliminary Data (if available) Research Design, Experimental Methods, Analytical Plan Potential Limitations and Contingencies Expected Outcomes and Future Directions Relevance to Child Health Project Timeline Bibliography Letter(s) of Collaboration / Confirmation of Outside Resources (if applicable) Department / Division Chairs Letter (submitted confidentially through online system) Letter from Postdoctoral Mentor or Residency Director (submitted confidentially through online system) Optional Recommendation Letter (submitted confidentially through online system) Research Project Summary and Performance Sites State the projects broad, long-term objectives and specific aims. Describe concisely the research design and methods for achieving these goals. This abstract is meant to serve as a succinct and accurate description of the proposed work when separated from the application. (300 word maximum) Key Words: Project Summary:  Performance Site(s) (institution, city, state): Non-Technical Project Summary Prepare a lay-language description of the proposed research that can be understood by the general public. Please aim for a reading level of 12th grade or below and spell out all acronyms. The summary must also describe the projects relevance to child health. (350 word maximum)  Impact Statement Please describe the impact that the successful conclusion of this project would have on child health. (200 word maximum) For basic science projects, please describe the relevance to child health or disease. For translational research, please describe the next steps in moving the research along the translational research spectrum towards clinical application relevant to child health. For T4 or public health research, please describe the implications for healthcare or public policy relevant to child health.  Applicant Independence / Institutional Commitment All sections must be addressed on this form by the Department or Division Chair. The completed form is then forwarded to the Applicant for upload. A separate letter of recommendation is submitted confidentially through the online application portal (see next page). This information will be held in confidence and used in the scientific review process only. Applicant Name / Academic TitleDates of Faculty Appointments previous Institution(s) and Current InstitutionApplicants Lab and Office Space / Size of Start-Up Package (if applicable); Note salary supportNational Search Conducted for this Position (Yes / No and # of applications received)   Describe the Institutions level of commitment to the Applicant and the long-term plan that is in place for his/her independent, professional development. The Scientific Review Committee views Institutional support as a positive indicator of the Institutions commitment in advancing the Applicants research career. Please specify the dollar amount for salary and note whether salary is included within a start-up package (use additional page as necessary). For candidates with clinical or teaching responsibilities, describe these activities and the approximate percentage of time to be spent (use additional page as necessary). For candidates with any current mentored award (including K Awards) please: Provide the scheduled end date of the K or other Award; and Clarify the Applicants current level of independence (use additional page as necessary). See next page regarding Letter of Support. Please note, Letters not directly addressing the Research Independence of the Applicant will be considered non-responsive to this requirement. Signature and Date:(Department or Division Chair) Department/Division Chairs Letter of Support The Applicant will send the Chair a request, through the Foundations online application system, for a Letter of Support. That email will include a link to upload the Letter of Support. Please submit this confidential letter on institutional letterhead and address the following: Confirmation of Applicants faculty appointment, date training was completed, and any leaves of absence (please see page 2 of the Application Guidelines for current allowances): PhD Scientists: The five-year window of eligibility begins on the first day of employment following completion of postdoctoral fellowship training, regardless of job title or place of employment. All previous faculty positions as well as any independent research position in a for-profit company, non-profit research institution or similar professional setting are included within the five-year window of eligibility. The first paragraph of the Department or Division Chairs letter must document the dates of the final post-doc appointment. Preference will be given to applicants who have moved out of their postdoctoral fellowship setting and have established independent research environments. Physician Scientists: The seven-year window begins at the completion of an ACGMEcertified subspecialty training program, or the equivalent for generalist fellowships. For physician-scientists who have not had fellowship training, the seven-year window begins at the completion of residency. The first paragraph of the Department or Division Chairs letter must document the start date of the fellowship, if applicable, the date when fellowship training was completed, and the total number of years the Applicant was employed following completion of fellowship or residency. Percent of protected time for research Applicants research independence and qualifications to conduct the proposed research Applicants potential to succeed in a health services, basic science or clinical research career Any other comments regarding strength of Applicants research project and/or academic accomplishments Current and Pending Support Total dollar amount of all Active or Pending grants included on these forms during the period of July 1, 2024 June 30, 2025: Total Active Grants, 7.1.2024 6.30.2025$Total Pending Grants, as of 4.1.2024$ Use a separate form for each Active or Pending Grant 1.Funding Source and Type of Grant (Example, NICHD R21):2.Role of Hood Applicant:3.Project Title:4.If Grant is Pending, Date of Notification:5.Award Period:6.Total Grant Amount (Direct Costs only): 7.Annual Direct Costs: If Hood Applicant is the PI, list the Total Direct Costs for the first year of the Hood Award. If you are not the PI, include only those Direct Costs allocated to your research.7.1.2024 6.30.2025$ 8. Describe any scientific or budgetary overlap with this proposal and outline a plan to avoid duplication of funding (use additional page as needed):  Form A-1 Year 1 Budget (funds requested from Hood Foundation) PERSONNEL (NAME, TITLE)ROLE% EFFORTSALARYFRINGETOTALS PERSONNEL SUBTOTALS$$$EQUIPMENT EQUIPMENT SUBTOTAL$SUPPLIES SUPPLIES SUBTOTAL$OTHER EXPENSES (List by category) OTHER EXPENSES SUBTOTAL$DIRECT COSTS, YEAR 1 $ INDIRECT COSTS @ 10%, YEAR 1 (maximum of $9,091) $ TOTAL COSTS, YEAR 1  $ 100,000.00 Form A-2 Year 2 Budget (funds requested from Hood Foundation) PERSONNEL (NAME, TITLE)ROLE% EFFORTSALARYFRINGETOTALS PERSONNEL SUBTOTALS$$$EQUIPMENT EQUIPMENT SUBTOTAL$SUPPLIES SUPPLIES SUBTOTAL$OTHER EXPENSES (List by category) OTHER EXPENSES SUBTOTAL$DIRECT COSTS, YEAR 2$ INDIRECT COSTS @ 10%, YEAR 2 (maximum of $9,091) $TOTAL COSTS, YEAR 2 $ 100,000.00Form B Budget Summary Column AColumn BColumn C (Other Support) *YEAR 1YEAR 2YEAR 1YEAR 2 PERSONNEL  EQUIPMENT SUPPLIES OTHER EXPENSES TOTAL DIRECT COSTS   TOTAL INDIRECT COST @ 10% (maximum of $9,091)   TOTAL COST FOR 12-MONTH PROJECT PERIOD  $100,000.00 $100,000.00 * If the research project uses additional support from other sources, these sources may be combined and listed in Column C. 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