Round 20: Operating + Ewing Sarcoma

C17Research Network Grant Application Form

The deadline for submitting the grantapplication is 4:00 pm MT on 29-Sep-2017

All applicants who submitted a Letter of Registration by the due date automatically proceed to the full grant application stage for Round 20.

  1. One (1) electronic copy of the application sent via email. Application, proposal, CVs, appendixes and any additional supporting documents must be assembled into a SINGLE PDF file in the order outlined in the “C17 Research Network-Research Funding Application and Award Guide”available at Applications spread over multiple files will not be accepted.
  2. In addition to the PDF of the application, please send a word document containing the i) project title, ii) name and contact information of the ONE PI, iii) names and contact information any co-Investigators, iv) lay abstract (150-200 words) and v) scientific abstract (500 words). This document is for administrative purposes, and there are no formatting requirements.
  3. Do not submit a hardcopy. Keep the original signature pages on file.
  4. Submit all applications to: C17 Research Network Committee,

Submit all applications to: C17 Research Network Committee,

c/o Leah Young, PhD

Email:


A. Administrative details

1. Project Title

Full title
Abbreviated title

2. Principal Investigator (one only)

Last name: / LAST NAME
First name: / First name and initial (if applicable)
Position:
Institute/affiliation:
Department:
Mailing address:
(room #, street, building)
City: / Province:
Postal code: / Email:
Telephone: / Fax:
Co-Investigator(s) if applicable
Last name: / LAST NAME
First name: / First name and initial (if applicable)
Position:
Institute/affiliation:
Department:
Mailing address:
(room #, street, building)
City: / Province:
Postal code: / Email:
Telephone: / Fax:
Co-Investigator(s) if applicable
Last name: / LAST NAME
First name: / First name and initial (if applicable)
Position:
Institute/affiliation:
Department:
Mailing address:
(room #, street, building)
City: / Province:
Postal code: / Email:
Telephone: / Fax:

3.Submission type

New submission / Resubmission / Renewal
C17 Competition / Ewing Sarcoma Competition

4. C17 Classification

Pick one below that applies the best to your proposed research. / Pick at least one below, and a maximum of three, that best categorizes the proposed research.
Oncology / Basic laboratory and translational research
Non-malignant hematological diseases and disorders / Biological sample banks and registries
Stem cell transplantation / Phase I, II, III and pilot studies
Health outcomes & health services research
Quality of life & psychosocial research
Prevention
Early detection, diagnosis and prognosis
Relapse/refractory/progressive disease
Genetics
Survivorship & late-effects
New therapies and druggable targets

See the award guide for definitions. To be used for reviewer selection and tracking.

5. Signatures

Principal Investigator:

Date:

Institution Hematology/Oncology Division Chief or C17 Director (or Department Chair if Division Chief/C17 Director is applicant):

Date:

Name:

Authorized Official at the Institution Paid (if applicable):

Date:

Name:

6. Collaborators and SiteCollaborators

Collaborators: List below the name, position, affiliation, address, phone, fax, e-mail address and project responsibilities of the Collaborators. Outline the specific role of the Collaborators with respect to the project. Include both duties and/or services to be provided by each individual.

Site Collaborators: Listing Site Collaborators indicates that they have read and understood the research proposal and have agreed to participate and enroll participants. Attach letters of support.

7. Multicentre Feasibility

Describe below the extent to which the proposed research is multicentre. For example, comment on collaboration, sample collection and/or patient recruitment across Canada. Provide strong justification if the proposed research is not feasible as a multicentre study.

8. Relevance to Pediatric Hematology, Oncology, or Hematopoietic Stem Cell Transplantation & Potential for practical application

Describe below the relevance/importance of this study to the focus areas and the potential of the study results to advance the treatment of pediatric hematology/oncology patient.

9. Lay Summary and Scientific Abstract

Lay Summary: Text must fit within the space provided (150-200 words, 6.5” x 3” text box, Calibri 11 pt or equivalent font). Please see the application and award guide for more detailed instructions.

Scientific Abstract:Text must fit within the space provided (500 words maximum, 6.5”x 6.5” text box, Calibri 11 pt or equivalent). Please see the application and award guide for more detailed instructions.

10. Health Canada CTA Approval
not required / Yes / pending / protocol in development
NOL date:

Note that, if applicable, CTA approval status will contribute to the assessment of study feasibility. Do not include study protocols, informed consent, or other regulatory document in your grant application. See the Application and Award Guide for more information.

11. Research Ethics Board and Other Approvals

What approvals will the proposed research require?
REB / yes no
Animal Care / yes no
Biohazard Containment / yes no
Will prospective biospecimens be added to registered or certified bio-repositories in accordance with the standards set by the CTRNet? / yes no N/A
REB Approval Status(if applicable)
Coordinating Centre / yes no pending
Sites Agreed/Interested in Participating. Insert site name(s) below / REB Status
yes no pending
yes no pending
yes no pending
yes no pending
yes no pending

Note that, if applicable, REB approval status will contribute to the assessment of study feasibility.

12. Curriculum Vitae of Principal Investigator and Co-Investigator(s)

Please see Application and Award Guide for instructions and section ordering, as well as instruction on documents required for collaborators.

13. Potential Reviewers
Potential Reviewers (upto four)
Name, position, address, phone, fax and email / Area of Expertise

B. Research Proposal

See the C17Application and Award Guide for instructions, page number restrictions, appendix information, formatting requirements and a suggested content outline. Note that reviewers are not required to read appendixes.

C. Other Information

  1. Ethical issues and study limitations.

Describe below any potential ethical, legal or social issues, and potential study limitations.

  1. Timeframe and feasibility

Provide a detailed timeline for the completion of the proposed research within 24-months.See award guide.

  1. Target audience and knowledge mobilization (KMb)

Please briefly outline (1 page maximum) a KMb plan that is suitable for the potential research results. If KMb is included in the budget, include additional details in the research proposal.

D. Funding Information Summary

C17 will consider requests for funding for 2 years for the following:

  • up to a maximum of $60,000.00per year for the Round 20 Operating Grant competition
  • up to a maximum of $50,000.00 per year for the Round 5 Ewing Sarcoma competition

Please consult the call for applications for details specific for the competition year.Projects longer than 2years may reapply for funding in subsequent grant competitions.

  1. Proposed project duration:
  2. Is the project feasible with only C17 funding?yes no
  3. Is other matched funding dependent on C17 funding?yes no
  4. Have you applied for other funds for this same proposal?yes no

If yes, where:

% overlap:

Decision date:

If overlap is less than 100%, please attach a copy of the research aims with overlap indicatedas well as the budget summary/justification.

  1. Have you secured other funds for this project?yes no

Funder:

Funding period:

Please attach a copy of the research aims and the budget summary/justification. Include funds in table below. See the Application and Award Guide for additional instructions.

E. Budget Request and Justification

Consult the Application and Award Guidefor more information. Add rows for category breakdown as required, or to list ‘other’ categories. Do not list research services under per case/site funding.

Budget Required / Year 1 / Year 2 / Total
Per case/site funding / $ / $ / $
Institution start-up funds / $ / $ / $
Research Personnel / $ / $ / $
Operating costs/supplies / $ / $ / $
Equipment/material / $ / $ / $
Project travel/ communication / $ / $ / $
Other / $ / $ / $
Total budget / $ / $ / $
Secured or matched non-overlapping funding / $ / $ / $
Requested other funding—non-overlapping portion
Funding requested from C17 Research Network / $ / $ / $

Budget Justification:

See the Application and Award guide for more information

Principal Investigator: LAST NAME, First name

Abbreviated Title: enter here