NKF Young Investigator Research Grant Application

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***STOP!***

Only use this form to start a NEW application.

If you've already started an application, use the link in the top right-hand corner to resume your application. Click "Next Page" to find and resume where you left off.



Welcome!

Please review the Instructions to Applicants for National Kidney Foundation Research Grants before completing this application.


All applications and supplementary materials are due by February 9, 2018.


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Applicant Information







Not applicable

Thank you for your interest, however, these grants are only open to physicians with nephrology training. If you have any questions please reach out to Julia Schrogin at julia.schrogin@kidney.org.
Project Information

Please do not exceed 255 characters, including spaces.



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About Applicant



Present Mailing Address






Permanent Mailing Address






Phone and Fax




Application Info

(if applicable)






Page 4

Sponsoring Institution










Business Official Information

Name of Official in Business Office










Division/Department Information


Department/Division Head Name










Other Personnel

Documentation of Collaborative Arrangements

Upload letter(s) from consultant(s) indicating their willingness to assist in the scientific pursuit of this project and any conditions on such assistance, if applicable. e.g. statistician who will be available to consult with regard to evaluation of data collected.

*All uploaded files must be in either PDF or Microsoft Word format


Click on the "Choose Files" button to find the appropriate file(s) on your computer. Clicking "Open" will upload the file(s). Your file will be automatically uploaded.











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Assurances

(Upload copies of relevant documents below.









Signatures

  • The individuals signing below attest that:

    1. research funded pursuant to this application will be conducted as described herein and
    2. that institutional resources will be made available, as specified, to pursue this investigation. They agree to follow the terms and comply with the policies for the research funding mechanism for which funding is sought.
  • Note: By signing this application electronically, I certify the information provided is accurate, and the department head and fiscal officer have reviewed all information. I understand that an electronic signature has the same effect and can be enforced in the same way as a written signature.





Name of Fiscal Officer:





Budget


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Facilities

Indicate the facilities available for the applicant's use and briefly describe their capacities, relative proximity and extent of availability for applicant's use. Use "other" to describe the facilities at any alternate or secondary research sites or field study sites pertinent to the applicant's research.






Department Chairman's Letter of Commitment/Verification 


Applicants for National Kidney Foundation research grants should attach a letter of commitment from the chairman of their department.

*All uploaded files must be in either PDF or Microsoft Word format


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Applicant Biosketch
Applicant Education
Degree 1






Degree 2






Degree 3






Applicant's Employment/Training

(after college) in chronological order
Activity/Occupation 1

From:


To:





Activity/Occupation 2

From:


To:





Activity/Occupation 3

From:


To:





Prior or Current Research Support

Academic and Professional Honors


Name of Dissertation Advisor or Chief of Service





Applications for Concurrent Support

List all pending support (training, research, supplies, travel, etc.) that would run concurrently with the period covered by this application whether or not you are the Principal Investigator. Include the type, date, source and amount.
Pending Support 1





Pending Support 2





Pending Support 3





Pending Support 4





Pending Support 5







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Research Experience





Approximate percentage proposed time in activities identified below during period of NKF grant.
%
%
%
%
%

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PART I: Research Proposal  

Attach pages describing research proposal in the format described in the respective Instructions to Applicants.
Please observe the page limitations for each section of the research proposal as described in the Instructions to Applicants.

*All uploaded files must be in either PDF or Microsoft Word format


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References

Please list on this page names and contact information of three persons who are familiar with your scientific interests and abilities.

Then, download the following form, and ask them to use it to submit references.

Reference Form - DOC

Have each reference e-mail her/his completed form to: Julia.Schrogin@kidney.org

Reference 1

Full Name








Reference 2

Full Name








Reference 3

Full Name








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Career Development Plans and Statement of Eligibility  

(to be completed by the Applicant)

Signatures

Note: By signing this application electronically, I certify the information provided is accurate. I understand that an electronic signature has the same effect and can be enforced in the same way as a written signature.


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