ࡱ> W bjbjzz ;zee , 8ITT>:+GGG666>>>>>>>$1BD@>66666@>GGU>6vGG>6>:#,b$G1X j$ >k>0>$REREb$b$Ev$6666666@>@>hR666>6666E666666666 : Alagille Syndrome Accelerator Award Application Face Sheet 2019 Grant Cycle One-Year/$25,000 Funding Period 9/15/19-9/14/20 (indirects are not allowed)  Contact: Kim Lezak, PhD, Interim Director, The Medical Foundation, at ϲ,  HYPERLINK "mailto:klezak@hria.org" klezak@hria.orgTotal Project Budget: Total Amount Requested from Accelerator Award: (Inclusion of overhead costs are not allowed) TITLE OF PROJECTKEY WORDS APPLICANT Male  FORMCHECKBOX  Female  FORMCHECKBOX Name and Degree:Full Academic Title:Department:Institution: Address:City, State, Zip:Telephone:Fax:Email:AUTHORIZED INSTITUTIONAL REPRESENTATIVEINSTITUTIONAL OFFICER TO RECEIVE FUNDSName:Name:Title:Title:Institution:Institution:Address:Payment AddressTelephone:Telephone:Email:Email: CERTIFICATION: We, the undersigned, certify that the statements contained herein are true and complete to the best of our knowledge, and accept the terms of the Alagille Syndrome Accelerator Award as documented in the Terms of the Award. The Applicants signature also confirms responsibility for obtaining any animal use, human subjects and/or other required institutional approvals. Signature of Institutional RepresentativeSignature of Applicant Date: Date:  Table of Contents Application Face Sheet 1 Table of Contents 2 Research Project Summary and Performance Sites 3 Biographical Sketch of Applicant Research Proposal Specific Aims Background and Significance Potential Impact Research Design and Methods Projected Timeline Collaboration description (if applicable) Bibliography Budget and Other Support Forms D-E Department Chair Letter of Recommendation 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 and will be posted on our website if the project is funded. 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'''---  2   '''---  2   '''--- 2 Email:   2   ''' ---  2     ''' ---  2     '''- @ !- - @ !-  - @ !- - @ !-  - @ !- - @ !-   - @ !-   - @ !- )---  2 %)  )''')---  2 %)  )''')---  2 %)  )''')---  2 %)  )''') ---  2 % )  ) ''') ---  2 % )  ) '''- @ !- - @ !-  - @ !- - @ !-  - @ !- - @ !-   - @ !-   - @ !- |*---  2 ,*|  |*''--- #2 ;*|CERTIFICATION:     2 ;k*|We, the undersigned, certify that the statements contained herein are true and complete to the best of our    ------------ F2 M'*|knowledge, and accept the terms of the   --- A2 M$*|Alagille Syndrome Accelerator Award    --- M2 M,*|as documented in the Terms of the Award.      82 _*|The Applicants signature also   2 _*|  2 _[*|confirms responsibility for obtaining any animal use, human subjects and/or other required     @Palatino Linotype--------- 12 q*|institutional approvals. ---  2 q*|  - - -   2 x*|  |*'''- @ !)-- @ !p)- - @ !)-- @ !)- - @ !)-- @ !)- - @ !)-- @ !z)- - @ !)-- @ !)- - @ !) -- @ !) - - @ !)- - @ !R*- - @ !R*- r|--- I2 )|rSignature of Institutional Representative   2  |r  r|'''|r---  2 yr|  |r''' |------ .2 | Signature of Applicant  ---  2 |    |'''| ---  2  |  | '''- @ !|-    - @ !|- $@"Arial---  2 $  $'''$---  2 +$  $'''r--- 2 rDate:   2 7r  r'''r--- >2 y"r  2 r   2 r  r'''---  2   ''' --- 2  Date:   2     ''' ---  2     '''- @ !-       - @ !- r@"Arial---  2 r  r'''r--- 2 ySr   2 r  r'''---  2   '''- @ !- - @ !$- - @ !-- @ !_-  - @ !- - @ !-- @ !r-  - @ !- - @ ! - - @ !-- @ !-- @ !_-  - @ !q-- @ !r-  - @ !-- @ !- - @ ! - - @ !-- @ !-  @Palatino Linotype--@Palatino Linotype--- "System_> u-kI--  00//..WTn ՜.+,D՜.+,X hp|  TMF~  -SMITH FAMILY NEW INVESTIGATOR AWARDS PROGRAM Title 8@ _PID_HLINKSAhjVmailto:klezak@hria.org  !"#$%&'()*+,-./0123456789:;<=?@ABCDEFGHIJKLMNPQRSTUVWXYZ[\]^_`abcdefghijklmnopqstuvwxyz{|}~Root Entry FY @Data > 1TableOEWordDocument ;zSummaryInformation(rLDocumentSummaryInformation8MsoDataStorePW 1X YUG5SFS==2`W 1X Item  PropertiesUCompObj r   F Microsoft Word 97-2003 Document MSWordDocWord.Document.89q