Application and Nomination for 2017 YCCI Scholar Awards

Instructions: Applicants must have a full-time Yale faculty appointment at the level of Assistant Professor, Instructor or

Associate Research Scientist at the time of the award and the appointment must not be contingent upon receipt of this award. Faculty who do not have an appointment as Assistant Professor must have a section of their Department Chair’s letter that describes the Department’s long-term commitment to the applicant and the applicant’s trajectory for promotion while at Yale. The trajectory for promotion must not be contingent upon receipt of this award.

Completed applications are due at 5:00 PM on June 6, 2017. Applicants will be provided with a link to the website where they can complete the required form and upload

the required documents either as a PDF or as a word document. Candidates MUST use the provided application and budget templates. Information collected regarding age, gender, ethnicity, race, disability and disadvantaged status will be kept

confidential and is only used for anonymous reporting to the NIH. Applicants should follow NIH format for fonts and margins.

Application Sections1. Abstract. Up to ½ a page. To be completed by candidate2. For resubmissions, applicants should address the feedback about the previous application in an “Introduction”

(maximum of 1 page). To be completed by candidate.3. Candidate/Career Development Plan. The applicant should describe his/her career plans including a path to

independence. The initial project should be described in context of a future research program. Maximum length is two page. To be completed by candidate.

4. Mentorship and Collaboration Plan. The applicant should describe the plan for mentorship and collaboration, including a mentorship committee that would meet periodically to review the Scholar’s research and career development should the grant be awarded. YCCI will assign an additional member to this committee. Maximum length is one page. Applicants who are requesting co-investigator support should include an extra half page to discuss how the co-investigator page will integrate into the research program. To be completed by candidate.

5. Research plan for the project to be undertaken, using the standard NIH format (Specific Aims, Background/Significance/Preliminary Data and Approach/Research Design and Methods). Maximum length is 5.5 pages. To be completed by candidate

6. References (as needed). To be completed by candidate7. Description of all current and pending support, with amounts and dates of all external and internal sources

(including start-up funds). To be completed by candidate.8. Other Support, Departmental Administration Page. This should provide a breakdown by percentage of all

current sources of support for the candidate, including all sources of funds with amounts and end dates for each external and internal source, including any start-up funds. If applicant has start-up funds, the amount and date received, and the current balance should be verified by a departmental administrator. This page is to be completed by candidate’s business office.

9. Detailed budget and justification using the included budget template. Candidates will be eligible for salary support for up to 75% professional effort (up to $100,000 including fringe) and up to $20,000 per year in research support. For candidates who are required to complete an MHS degree, the tuition cost ($7,500 in year one) must be included in the request for research support. Surgeons who are applying for salary support for less than 75% professional effort should include a statement that they need to have more than 25% professional

effort devoted to direct patient care to maintain surgical skills. This section is to be completed by applicant in conjunction with the applicant’s business office.

10. Letter of support from the person making the nomination detailing the qualifications of the candidate and any mentoring arrangements that are currently in place (maximum of 2 pages). To be completed by the nominator.

11. Letters of support from the candidate’s mentors and collaborators (maximum of 1 page each). To be completed by mentors and collaborators.

12. Candidate’s NIH-formatted biosketch. To be completed by candidate.13. NIH biosketches from the candidate’s mentors and collaborators (maximum of 5 page each). To be completed by

mentors and collaborators. 14. If the nominator is not the department chair, section chief, or center director of the department in which the

applicant holds a primary faculty appointment, that chair/chief/director where the applicant holds their primary faculty appointment must write a letter spelling out the department’s long-term commitment to the candidate’s development as an independent investigator (maximum of 1 page). If the nominator is the chair/director then this information should be included in the letter of support. Faculty who do not have an appointment as Assistant Professor must have a section of their department chair’s letter that describes the department’s long-term commitment to the applicant and the applicant’s trajectory for promotion while at Yale. The trajectory for promotion must not be contingent upon receipt of this award. Nominations from the Schools of Nursing or of Public Health should come from the respective Dean. To be completed by department chair/ center director (if different from part 10).

15. A signed copy of the most recent letter appointing the candidate to faculty status should be included. This should be an official offer letter and include details of the applicant’s position. This will be used for administrative purposes only.

The order of your application should be as follows:Part 1 Abstract/summary Up to ½ pagePart 2 Introduction (for resubmissions) Up to 1 page, if neededPart 3 Candidate/Career Development Plan Up to 2 pagesPart 4 Mentorship and Collaboration Plan Up to 1 pagePart 5 Research Plan Up to 5.5 pages Part 5a Specific Aims Up to ½ page Part 5b Significance Background/Preliminary Data Up to 2 pages Part 5c Approach Up to 3 pagesPart 6 References As neededPart 7 Other Support As neededPart 8 Other Support Departmental Administration As neededPart 9a Detailed Budget As neededPart 9b Budget Justification Up to 2 pagesPart 10 Letter of nomination Up to 2 PagesPart 11 Letters of Support from Candidate’s mentors and

collaborators Up to 1 pages each

Part 12 Candidate’s NIH-formatted biosketch Up to 5 pagesPart 13 Biosketches from Candidate’s Mentors and collaborators Up to 5 pages eachPart 14 Letter of support from the Chair/Dean/Chief (to be submitted

directly to Nicholas Licht (Nicholas.Licht@yale.edu)Up to 1 pages

Part 15 A copy of the current appointment letter appointing the candidate to faculty status within the department.

As needed

Project Summary/Abstract (Limited to ½ page of text):

Resubmission Page

For resubmissions, applicants should address the feedback about the previous application in an “Introduction” (maximum of 1 page).

Candidate/Career Development Plan. The applicant should describe his or her background and training and career plans including the path to independence. Maximum length is two pages.

Mentorship and Collaboration Plan. The applicant should describe the mentorship and collaboration plan, and the mentoring committee that would meet periodically to review the Scholar’s research and career development if the grant is awarded. YCCI will assign an additional member to this committee. Maximum length is one page.

Research Plan

Specific Aims (Limited to ½ page of text):

Significance/Background/Preliminary Data (Up to 2 pages including text and graphics):

Approach/Methods (Limited to 3 pages including text and graphics):

References (As needed):

Other Support

This section should include a full description of other support, including all current and pending sources of funds with amounts and dates for each for all sources (external and internal, including any start-up funds) and any grants that are planned for submission prior to September 1, 2017. The required template can be found at: http://grants.nih.gov/grants/funding/phs398/othersupport.doc

Other Support, Continued

Must be completed by Departmental Administrator or Business Office:

Please submit a breakdown by percentage of all current sources of support for the candidate, including all sources of funds with amounts and end dates for each for all sources (external and internal, including any start-up funds). A signed copy of the current appointment letter of the candidate to faculty status within the department is also required and should be included. If applicant has any start-up funds, the amount of said funds, their date of initiation, and the current balance should be disclosed.

Name of candidate:

Breakdown of current effort:

Example:

30% - Yale-based Clinical/Patient Care 10%- VA-based Clinical/Patient Care10%- Departmental GA funding50%- RO1 of Robert Sherwin as an associate research scientist

Name of departmental representative completing this section:

Phone:

Email:

Signature of departmental representative:

Signature Date

Program Director/Principal Investigator (Last, First, Middle):      

DETAILED BUDGET FOR INITIAL BUDGET PERIODDIRECT COSTS ONLY

FROM THROUGH

09/01/17 08/31/2018 List PERSONNEL (Applicant organization only) Use Cal, Acad, or Summer to Enter Months Devoted to Project Enter Dollar Amounts Requested (omit cents) for Salary Requested and Fringe Benefits

NAMEROLE ONPROJECT

Cal.Mnths

Acad.Mnths

SummerMnths

INST.BASESALARY

SALARYREQUESTED

FRINGEBENEFITS TOTAL

      PD/PI                                          

                                                     

                                                     

                                                     

                                                     

SUBTOTALS                  CONSULTANT COSTS           EQUIPMENT (Itemize)     

     SUPPLIES (Itemize by category)     

     TRAVEL           INPATIENT CARE COSTS            OUTPATIENT CARE COSTS            ALTERATIONS AND RENOVATIONS (Itemize by category)           OTHER EXPENSES (Itemize by category)     

     CONSORTIUM/CONTRACTUAL COSTS DIRECT COSTS      

TOTAL DIRECT COSTS FOR INITIAL BUDGET PERIOD $      

PHS 398 (Rev. 6/09) Page     Form Page 4

Program Director/Principal Investigator (Last, First, Middle):      

DETAILED BUDGET FOR INITIAL BUDGET PERIODDIRECT COSTS ONLY

FROM THROUGH

9/01/2018 8/31/2019 List PERSONNEL (Applicant organization only) Use Cal, Acad, or Summer to Enter Months Devoted to Project Enter Dollar Amounts Requested (omit cents) for Salary Requested and Fringe Benefits

NAMEROLE ONPROJECT

Cal.Mnths

Acad.Mnths

SummerMnths

INST.BASESALARY

SALARYREQUESTED

FRINGEBENEFITS TOTAL

      PD/PI                                          

                                                     

                                                     

                                                     

                                                     

SUBTOTALS                  CONSULTANT COSTS           EQUIPMENT (Itemize)     

     SUPPLIES (Itemize by category)     

     TRAVEL           INPATIENT CARE COSTS            OUTPATIENT CARE COSTS            ALTERATIONS AND RENOVATIONS (Itemize by category)           OTHER EXPENSES (Itemize by category)     

     CONSORTIUM/CONTRACTUAL COSTS DIRECT COSTS      

TOTAL DIRECT COSTS FOR INITIAL BUDGET PERIOD $      

PHS 398 (Rev. 6/09) Page     Form Page 4

Detailed Budget and Justification

Detailed budget and justification in template word file. All candidates will be eligible for 75% of salary (up to $100,000 including fringe) and up to $20,000 of research support. Support may not be requested for a mentors or faculty collaborators. A detailed budget justification is required for all costs. If a candidate proposes sharing costs of their salary with another entity (eg, a Department or a Mentor), please outline from where the cost sharing support will come. Please use an additional page if needed.

Letter of Nomination

Letter of support from the person making the nomination, commenting on the qualifications of the candidate and any mentoring arrangements that are currently in place (maximum of 2 pages).

Letters of Support

Letter of support from candidate mentors and collaborator (limit 1 page each).

Candidate’s NIH-formatted Biosketch:

Templates and samples can be found at: http://grants.nih.gov/grants/funding/424/SF424R-R_biosketch_VerC.docx http://grants.nih.gov/grants/funding/424/SF424R-R_biosketchsample_VerC.docx

Additional NIH-formatted Biosketch:NIH biosketches from mentors and collaborators (5 pages each)

Additional letter of support:If the nominator is not the department chair, section chief, or center director of the department in which the applicant holds a primary faculty appointment, that chair/chief/director where the applicant holds their primary faculty appointment must write a letter spelling out the department’s long-term commitment to the candidate’s development as an independent investigator (maximum of 1 page). If the nominator is the chair/director then this information should be included in the letter of support. Faculty who do not have an appointment as Assistant Professor must have a section of their department chair’s letter that describes the department’s long-term commitment to the applicant and the applicant’s trajectory for promotion while at Yale. The trajectory for promotion must not be contingent upon receipt of this award. Nominations from the Schools of Nursing or of Public Health should come from the respective Dean.

Appointment LetterA signed copy of the most recent letter appointing the candidate to faculty status should be included. This should be an official offer letter and include details of the applicant’s position.

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