Instructions for the Submission of the Letter of Intent

Transcription

1 Instructions for the Submission of the Letter of Intent Letters of Intent must be submitted no later than 23:59 CET, 26 November Please read the Call For Letters of Intent carefully. Only applications that fully adhere to the requirements set out in the Call For Letters of Intent will be considered to be eligible. - You may complete either the PDF or Word version of the Letter of Intent Form. This is the PDF version. Using the PDF version Letter of Intent form: Download and complete the form. Submit the PDF file to the CIPHER Secretariat. Using the Word version Letter of Intent form: Download and complete the form. When you are finished, save the form as a PDF file. Submit the PDF file to the CIPHER Secretariat. Note: If you are using a Mac, formatting changes in the Word version of the Letter of Intent may occur. We encourage Mac users to complete the PDF version of the Letter of Intent. - The Letter of Intent must be submitted electronically, in the format provided, to cipher@iasociety.org no later than 23:59 CET, 26 November Only applications in English will be accepted. Eligible Letters of Intent will be reviewed by a Scientific Review Committee. Applications will be prioritized on their ability to demonstrate maximum impact on the optimization of paediatric HIV diagnosis, prevention, treatment and care in resource-limited settings, as well as on collective capacity building in the grantee s home country and/or research performance sites. Short-listed candidates will be notified by December 2012 and will be invited to submit a Full Proposal. Candidates will have nine weeks to prepare and submit the Full Proposal. Details and instructions for the preparation of the Full Proposal will be provided upon notification. The implementation of this project was made possible through an unrestricted grant from ViiV Healthcare. The content and structure of the project has been guided by paediatric experts convened by the IAS.

2 CIPHER RESEARCH GRANT FORM 1: COVER PAGE 1.1 Principal Investigator Name (last name, first name) Date of birth (day/month/year) Gender Nationality (as it appears in your passport(s)) Phone (including country code) Highest degree/year obtained Mailing address institution Institution (university/organization, department) 1.2 Research Project Project title Research topic Clinical Operational Human Subject Research Duration of proposed period of support Number of month: Funds requested for total period Direct cost: $ Total cost: $ Project summary (maximum 300 words) 1

3 CIPHER RESEARCH GRANT FORM 1: COVER PAGE Signature of Principal Investigator/date I, the undersigned, certify that the information provided in the Letter of Intent is true and complete to the best of my knowledge. I agree to comply with any resulting terms if I accept an award. I am aware that any false, fictitious, or fraudulent statement may subject me to criminal, civil, or administrative penalties. Date In lieu of Applicant s Signature 2

4 CIPHER RESEARCH GRANT FORM 2: BIOGRAPHICAL INFORMATION 2.1 Principal Investigator Name (last name, first name) Education (degree, name and location of institution, major field of study, study period month/year-month/year) Please list all post-secondary education and/or training in which a diploma or degree has been obtained, beginning with the most recent. Additional training (name and location of institution, activity, training period month/year-month/year) Please list any relevant non-degree training, including postdoctoral research training, internship, and residency. Publication record List your most significant publications in peer-reviewed journals (maximum publications). 2

5 CIPHER RESEARCH GRANT FORM 2: BIOGRAPHICAL INFORMATION Employment history (position title, name and location of institution, employment period month/year-month/year) Please list all relevant positions, beginning with the most recent. Academic and professional honours (name and source of award, dates) List maximum six academic and professional honours, including scholarships, fellowships, and awards. 3

6 3.1 Research Project Project title Research topic Clinical Operational Study site(s) (if applicable) Background and hypotheses (maximum 400 words) 4

7 Specific aims (maximum 300 words) 5

8 Brief preliminary data (if any) (maximum 300 words) 6

9 Research methodology (maximum 600 words) 7

10 Relevance and potential impact (maximum 300 words) 8

11 References 9

12 3.2 Research Budget Duration of proposed period of support Number of month: Funds requested for total period Direct cost: $ Total cost: $ Current research funding for all studies involving the applicant (title of project, name of PI, funding source, amount of funding in US$, period of funding month/year-month/year, function of applicant in study, objectives of project) Past research funding for all studies involving the applicant (title of project, name of PI, funding source, amount of funding in US$, period of funding month/year-month/year, function of applicant in study, objectives of project) 10

13 CIPHER RESEARCH GRANT FORM 4: LETTER OF SUPPORT 4 Letter of Support Authorized officer of institute (name and position title) Contact details ( , phone, mailing address) Please use the left toolbar to attach a copy of a letter from an authorized officer of your institute (e.g., dean, head of department, executive director of organization) indicating the commitment of the institute to support the proposed project. Instructions: click on the paperclip in the left toolbar>options>add attachment 11