Intro 17% You can press the Print button to view a PDF of the complete (blank) application or save your responses.

Transcription

1 Intro 17% Welcome to the Branch Out Grant Application for our MS NeuroCAM Seed Grant. You can press the Print button to view a PDF of the complete (blank) application or save your responses. If you cannot complete the online submission in one sitting you can click the "Save for Later" link at the bottom of the page. Doing so will provide you with a custom link that you can use to return to the form at a later time. Remember to save that link in a safe place or it to yourself. 1/9

2 Applicant Information 33% Principal Investigator Name* First Last Professional Title* Institutional Affiliation* * Phone* ### ### #### Address* Street Address Street Address Line 2 City Region Postal / Zip Code Country Please upload your CV Canadian Common CV (CCV) formatting strongly recommended ( Choose File No file chosen Choose files or drag here Co-PI Name First Last Professional Title Institutional Affiliation * Phone* ### ### #### 2/9

3 Address* Street Address Street Address Line 2 City Region Postal / Zip Code Country Please upload your CV Canadian Common CV (CCV) formatting strongly recommended ( Choose File No file chosen Choose files or drag here 3/9

4 Project-Scientific Overview 50% Project Title: Type of research: Check all that describe your research Basic Research Translational Research Clinical Trial Relevant neurocam modality: Check all that describe your research Please see our website for guidance Nutraceutical Mind and Body Personalized Medicine Tech Using the various headings below, please provide a brief description of your project. Please be as clear and concise as possible. There is a separate field at the bottom for your references across all sections. Lay Summary of Project (500 words max) Background: Please describe the current state of research on your topic (1000 words max) Specific Aims and Hypotheses: Please list up to 3 specific aims and their coresponding hypotheses (200 words max) 4/9

5 Methods: Please describe the procedures that will be used to execute your study. Where possible, please provide citations to support your decisions. (1000 words max) 5/9

6 Project-Logistics Overview 67% Funding amount requested: up to $50, 000 CAD Lower requests are more likely to be funded, so please only request what is safely nessesary to complete the project. Budget: Please outline your proposed list of expenses for the project, and the justification of each item. (700 words max) Timeline: Please list out the study timeline for the 1 year of funding (1000 words max) Feasability: Please outline any feasibility concerns for your project, as well as steps taken to address them (500 words max) Power: Please justify your proposed sample size with a power calculation. References Please list your references for all sections above here: 6/9

7 Impact 83% Academic impact: Please describe how your project advances the scientific understanding of MS and/or neurocam treatments of it Please describe the project s relation to neurocam. This should include a classification of 1 or more types of neurocam ( Please describe your knowledge translation plan: How will you distribute the knowledge gained from this project to the more broad nonacademic community? Please consider alternatives to traditional academic journals and conferences Please describe how this project is a new venture for your lab, and assuming success, where this new line of research would lead If this project will provide pilot data for subsequent grant applications, please indicate which grants will be applied to 7/9

8 Collaborations: Please describe any collaborative efforts, either between academic institutions, or with community partner organizations. Please make sure the relative contrition of any/all collaborators is clear. Project in a Tweet: Please demonstrate your knowledge translation skills by communicating your project's main ideas in 140 characters or less 8/9

9 Final Submission 100% Please review your application to ensure its completeness and accuracy. If you are having any technical difficulty, please for assistance. Send me updates on Branch Out Foundation activities, events, and news. Send me occasional text messages for reminders, deadlines, events, etc. Digital signature* Please click down and drag to draw your signature. It doesn't have to be pretty :) 9/9