FRANCISCO J. VARELA RESEARCH AWARD

REPORTING FORM

______

Completion and submission of this Reporting Formon or beforeDecember 1, 2015is a requirement of the grant you received from Mind Life Institute. Please complete this form electronically and email toand attach related documents.

Date:

Grant ID Number:

Project Title:

Type of Report(check one): Progress:Expected Completion Date:

Final: Completion Date:

Name:

Degree:

Email Address:

Office Phone:Mobile Phone:

Mailing Address:

Lab/Institution where project is being (or was) conducted:

Name of Research Mentor/Advisor & Title:

Advisor’s Email Address: Advisor’s Office Phone:

Project’s Funding Sources and $ Amounts (if any) other than Varela Award:

Please provide the following (attached as separate documents):

  1. The appropriate report
  • Progress Report (250 words minimum) if the project has not been completed by December 1; or
  • Final Report (250 words minimum) if the project has already been completed.

All reports should include the following information:

  • What are the original goals of the grant?
  • What was/is being accomplished toward achieving those goals?
  • What problems were/are being encountered, if any, and what have you done to address these?
  • What are your future plans for this project?
  1. Financial report (a detailed financial expense report, not to exceed one page, detailing how the Mind and Life grant was/is being spent).

Please Answer the Following Questions:

  1. Have you been granted an extension by Mind and Life’s Varela Committee?
  • If “yes,” please provide reason, date of extension, approved by and expected date of completion.
  1. Which general research area does your Varela project fall under? Select all that apply.

Basic Science

Clinical Science

Social Science

Philosophy and Humanities

Other (please specify): ______

  1. Have you submitted results from your project for publication?
  • If “yes,”please provide full details and manuscript(s) attached as pdf file(s) along with this Report. Please include all publications related to this grant, even if you’ve sent them before.
  • If “no,” please explain why, and provide details of plans for future publication, including anticipated journal(s) for submission.
  1. Has your research been presented in poster(s) or other format(s) at scientific conferences?
  • If “yes,” please provide full details, including authors, dates, titles and sites of presentations and attach PowerPoint of poster if available.
  1. Have you given public talks on this research? If so, how many?
  1. If your Varela project has been completed, did this lead to further research projects and/or funding?
  • Please provide details of how this was obtained, amounts and affiliations, and plans for the funding. Please list all grants stemming from the Varela Award project.
  1. (Final Report Only) Has your career developed since the Varela Award, and how has it helped you?
  • Please comment on the following:
  • Have you obtained a faculty position?
  • Do you run a lab or center?
  • Do you advise students who are engaged in similar work? If so, how many?
  • Have you taught courses related to this material? If so, please list course titles and semesters.

Francisco J. Varela Research Grant Reporting Form

Page 1 of 1