Research Grant Submission Form 2011/2012

Funding Period 1 year

Basic information

Required fields are marked with a *.

Title of Research Proposal:

Author’s Name*:

Author’s Email*:

Amount of Funds Requested:

New Proposal or Renewal

New Proposal. Please complete Parts B, D and E

Renewal of Current Project. Please complete Parts C, D and E

Note: Only two renewals of projects previously funded by the Glaucoma Research Society of Canada will be considered.

Summary

Please summarize the objective, hypothesis and plan of your research proposal on the rest of this page.

PART B: For New Proposals

1.Please describe your FULL RESEARCH PROPOSAL (maximum 3 pages)

2. Budget Breakdown

PART C: For Renewal of Current Project

Note: Only two renewals of projects previously funded by the Glaucoma Research Society of Canada will be considered.

1. Please summarize how GRSC’s 2010/2011 grant helped your project progress (maximum 1 page)

2. Please describe in detail (maximum 2 pages) the research you want to continue to conduct

3. Budget Breakdown

PART D: Curriculum Vitae of Principal Investigator and Co-Applicants

Please provide the following information for the principal investigator and co-applicants:

1. Eligibility:

a) Current University appointment:

b) Academic Research Program:
Masters
PHD Thesis

Name of supervising preceptor:
University
Academic Hospital

c) Post Doctoral Student Studies/Clinical Research Fellowships:
Name of supervising Clinician Researcher in Canada:

Degrees and diplomas, including dates and confirming institutions (attach sheets as required)
Publications in peer reviewed journals during the past 10 years (attach sheets as required)
Other grants, including those that overlap with current grant applications (attach abstracts)

Email forms as attachments to info@glaucomaresearch.ca

PART E: Applicant(s) Information

Principal Investigator

Name/Title:

Address:

Tel:
Fax:
e-mail:

Co-Principal Investigator

Name/Title:

Address:

Tel:
Fax:
e-mail:

University/Hospital Signing Authority

Name/Title:

Address:

Tel:
Fax:
e-mail: