KirschsteinNRSA Individual Fellowship ApplicationTable of Contents |
NAME OF APPLICANT (Last, first, middle initial)
|
|||||
Section I — Applicant/Fellow |
Page Numbers (Number pages consecutively at the bottom throughout the application. Do not use suffixes such as 6a, 6b.) |
|||||
Face Page |
1 |
|
||||
Sponsor’s Contact Information, Description (Form Page 2) |
2 |
|
||||
Training & Career
Goals, Activities Planned Under This Award, Training Site(s),
|
3 |
|
||||
Table of Contents (Form Page 4) |
|
|
||||
Biographical Sketch – Applicant/Fellow (not to exceed four pages) |
|
|
||||
Previous Research Experience (Form Page 5) |
|
|
||||
Research Training Plan |
|
|
||||
1. Introduction to Resubmission Application (not to exceed 1 page) |
|
|
||||
2. Specific Aims |
|
|
||||
3. Research Strategy (not to exceed 6 pages) |
|
|
||||
4. Inclusion Enrollment Report (for Renewal applications only) |
|
|
||||
5. Progress Report Publication List (for Renewal applications only) |
|
|
||||
6. Human Subjects (Required if Item 9 on the Face Page is marked “Yes”) |
|
|
||||
7. Clinical Trial |
|
|
||||
8. Agency-Defined Phase III Clinical Trial |
|
|
||||
9. Protection of Human Subjects (Required if Item 9 on the Face Page is marked “Yes”) |
|
|
||||
10. Inclusion of Women
and Minorities (Required
if Item 9 on the Face Page is marked “Yes” |
|
|
||||
11. Targeted/Planned Enrollment Table (for new and continuing clinical research studies) |
|
|
||||
12. Inclusion of Children (Required if Item 9 on the Face Page is marked “Yes”) |
|
|
||||
13. Vertebrate Animals (Required if Item 10 on the Face Page is marked “Yes”) |
|
|
||||
14. Select Agent Research |
|
|
||||
15. Bibliography and References Cited (formerly “Literature Cited”) |
|
|
||||
16. Resource Sharing |
|
|
||||
17. Respective Contributions |
|
|
||||
18. Selection of Sponsor and Institution |
|
|
||||
19. Responsible Conduct of Research |
|
|
||||
Section II — Sponsor’s/Co-Sponsor’s Information |
|
|
||||
Biographical Sketch—Sponsor/Co-Sponsor (not to exceed four pages each) |
|
|
||||
Research Support Available |
|
|
||||
Previous Fellows/Trainees |
|
|
||||
Training Plan, Environment, Research Facilities |
|
|
||||
Number of Fellows/Trainees to be Supervised |
|
|
||||
Applicant’s Qualifications and Potential |
|
|
||||
Checklist (Completed by Fellow/Applicant & Sponsoring Institution) |
|
|
||||
Section III — Letters of Reference (Minimum of 3) (See instructions for submission of references.) List full name, institution, and department of individuals submitting reference letters.
|
||||||
Appendix Appendix (Five identical CDs) |
|
Check if Appendix is Included |
PHS 416-1 (Rev. xx/09) Page 4 Form Page 4
File Type | application/msword |
File Title | PHS 416-1fp4 (Rev. xx/09), Table of Contents, Form Page 4 |
Subject | Ruth L. Kirschstein National Research Service Award Individual Fellowship Application |
Author | DHHS, Public Health Service |
Last Modified By | Leslie Dorman |
File Modified | 2009-02-25 |
File Created | 2009-02-25 |