Form-Kuhn Research

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The Jay Kuhn Memorial Hodgkin Research Award

Juravinski Cancer Centre Foundation

Research Application Form

The Juravinski Cancer Centre Foundation’s (JCCF) main purpose in every undertaking is to champion and advance the vision and mandate of the Juravinski Cancer Centre. Through the generosity of our donors, we fund capital redevelopment projects, purchase medical equipment and technology, we invest in research and support opportunities for the professional development of our hospital staff.

It is only through research that we can unlock the mysteries of disease and make significant strides in the fight against it. We are fortunate that a wide variety of world-class research is being performed every day at the Juravinski Cancer Centre. Each year, the foundation awards grants as part of its commitment to research conducted at the Juravinski Cancer Centre. Research projects must be compatible with the Juravinski Cancer Program’s (JCP) mission, strategic plan and management priorities.

Scope of the Awards Program:

This award, named in memory of Jay Kuhn, is designed to provide funding support for

Hodgkin Disease or non Hodgkin Lymphoma Research at the Juravinski Cancer Centre.

The Program will provide an annual award in support of Hodgkin Disease or non Hodgkin Lymphoma research initiatives undertaken by staff employed within the Oncology Program at Hamilton Health Sciences and/or be a member of the Department of Oncology at McMaster University.

Eligible projects must meet all of the following criteria:

·  The principal investigator or co-principal investigator must work at Hamilton Health Sciences or be a full member of the Department of Oncology at McMaster University.

·  The principal and/or co-principal investigator must not currently have an active JCCF funded grant (i.e. research in progress and/or the final report has not been submitted to the JCCF).

·  Co-investigators may include individuals from Hamilton Health Sciences, the Department of Oncology at McMaster University and/or other organizations.

·  Grant should be for projects that can ideally be completed over a one year funding period. Multi-year grants are not eligible.


Funding guidelines:

·  Grants will be awarded to a maximum of $10,000 from the Kuhn Award.

·  Applicants can also request matched or additional funding from the Juravinski Cancer Centre Foundation general grant fund to a maximum of $15,000 for a total combined award of $25,000. The request for additional funding should be clearly outlined in the proposal and justification for this additional funding should be provided in terms of the overall goals and significance of the proposed research and the budget.

·  A complete application must include:

1.  A clear summary of the proposed research that clearly states the case for support including methods and procedures

2.  A detailed budget, with supporting documentation

3.  A signature from the Chair of the Department of Oncology and Head of Cancer Research, Hamilton Health Sciences

4.  A timeline showing milestones and proposed completion of the project

Applications that do not include these items will not be considered.

For the 2010 year, applications are due April 1, 2010. The Grants and Distribution Committee will review all applications submitted by the end of May for grants to be made in July 2010. All completed applications must include 8 full copies plus 8 copies of the “Lay Abstract” (*see pg. 6) and be submitted to:

Megan Dunlop-Elms

Donor Relations Officer

Hamilton Health Sciences Foundation

40 Wellington Street North

(can be sent by internal hospital mail)

Signatures:

Project Title

/

Amount requested

Principal Investigator Name and Signature / Supervisor Name and Signature (if submitted by PhD student or Fellow)
Location / Telephone / Extension

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Co-Principal Investigator Name and Signature (if applicable) / Supervisor Name and Signature (if submitted by PhD student or Fellow)
Location Telephone / Extension

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Signature of Head of Cancer Research, Hamilton Health Sciences and Chair Department of Oncology

/ /

Date

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APPLICATION FOR RESEARCH FUNDING

Project Title:

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Principal Investigator:

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Name / Degree
Academic Title (if appropriate) / Oncology Program Area
Address / Postal Code

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Check List for Principal Investigator’s eligibility:

Employed or works at HHS and/or a full member of the Department of Oncology
No active JCCF funded grants (i.e. research in progress and/or final report to JCCF has not been submitted)

Co- Principal Investigator (if applicable):

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Name / Degree
Academic Title (if appropriate) / Oncology Program Area
Address / Postal Code

Co-investigators:

Name / Degree
Academic Title (if appropriate) / Oncology Program Area
Address / Signature of Co-investigator
Name / Degree
Academic Title (if appropriate) / Oncology Program Area
Address / Signature of Co-investigator


Co-investigators continued:

Name / Degree
Academic Title (if appropriate) / Oncology Program Area
Address / Signature of Co-investigator
Name / Degree
Academic Title (if appropriate) / Oncology Program Area
Address / Signature of Co-investigator

Project Title ______

Principal Investigator ______

Duration of Proposed Research ______

Expected Start Date ______

mm/dd/yy

Funding Requested: (please list amounts with supporting documentation where required)

-  Total
-  Personnel
-  Expendable Supplies
-  Services
-  Equipment

Research Category: (basic, translational, clinical trials, health services)

Indicate if Proposal Involves:

Human experimentation:
Animal experimentation:
Biohazards:

Include documentation indicating appropriate guidelines will be observed and that appropriate JCC and hospital (if applicable) bodies have approved application.


Lay Abstract: (maximum 250 words summarizing research project in language suitable for lay audiences and reviewers)

Scientific Abstract: (maximum of 250 words summarizing research proposal)

Research Proposal: (maximum of 6 single spaced pages)

Proposal Must Include:

  1. Objectives
  2. Background
  3. Rationale

4.  A clear description of the study methods including the following:

·  Study design

·  Setting, sample and sample size

·  Procedures for data collection and data analysis

·  Ethical issues

  1. Significance
  2. Budget Detail and Justification*

·  Complete an itemized budget that provides rationale of how these expenses are necessary to conduct the proposed research (i.e. attach quotes/estimates for personnel, services, equipment, supplies, communication, travel etc.)

  1. Brief summary describing the role, expertise and time commitment each member of the research team will provide to ensure the successful completion of this study
  2. References (not included in 6 page limit)

*Eligible budget items are those costs associated with study setup, data collection, and data analysis. Possible examples include expenses related to: salary for research staff support, assays, lab equipment, office supplies, postage, printing, computer equipment, software programs for data analysis, telephone and travel.

Appendices may be attached at the discretion of the applicant.

Abbreviated Curriculum Vitae: (maximum 3 pages plus publications from last 3 years per investigator)

Other Funding:

List prior JCCF funded grants as Principal Investigator including date of funding, title and amount.

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Indicate all other active grants including amounts received, grants currently pending review including amounts requested, and percent of overlap with current proposal.

Accountability:

·  The principal investigator and co-principal investigator are required to abide by the Foundation “Terms of Funding Agreement” (Sample attached) if proposal receives funding.

·  The principal investigator and/or co-principal investigator are required to submit an interim report to the Foundation prior to receiving their final grant installment.

·  The principal investigator and/or co-principal investigator are required to submit a final report to the Foundation within 6 months of completion of the project.

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FOR FOUNDATION USE ONLY – NOT TO BE COMPLETED BY APPLICANT

Foundation Check List:

Principal investigator or co-principal investigator is employed or works at HHS and/or a full member of the Department of Oncology
No active JCCF funded grants (i.e. research in progress and/or final report to JCCF has not been submitted

Approval/Recommendation of Grants and Distribution Committee

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Signature of Chairman Date

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Approval/Recommendation by The JCCF Board

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Signature of Chairman Date

JCC Foundation Grants & Distribution

Terms of Funding Agreement

In order to receive funding, please note the following:

1.  Upon receipt of this signed document, the Foundation will advise JCC Finance office to activate an account in your name, specifically for this grant.

2.  The Foundation will transfer the first quarterly installment of your grant (25%) to JCC Finance.

3.  The Foundation will transfer two subsequent installments of 25% each over the next 2 quarters to JCC Finance.

4.  The final installment will be transferred into your account after the Foundation receives, in writing, an interim project report including:

-  How the funds have been used to date

-  Expected date of completion

Important Note: Failure to submit an interim project report will result in delay or refusal of your final installment.

5.  A final report must be submitted to the Foundation Office within 6 months of the completion of the research project including:

-  A breakdown of how the funds were used (final financial report)

-  A summary of publications referencing the research project

-  An abstract of research outcomes

Important Note: Failure to submit a final report will affect future grant application consideration by the Foundation.

6.  Funds not accessed within 12 months will be returned to the Foundation by JCC Finance and recipient must re-apply for funding approval.

7.  These funds are encumbered for this specific project and any funds, which are not used, must be reimbursed back to the Foundation Office.

8.  Any publications resulting from this project must acknowledge the support of the Juravinski Cancer Centre Foundation.

______

Expected Start Date - (mm/dd/yy) Expected Date of Completion - (mm/dd/yy)

______

Signature of Principal Investigator Date (mm/dd/yy)

______

Signature of Vice-President, Development Date (mm/dd/yy)

JCC Foundation

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