AACT Toxicology Trainee Research Grant Application

AACT Toxicology Trainee Research Grant

Don't forget to complete sections 7-9 using the document found in the AACT Toxicology Trainee Research Grant webpage (http://www.clintox.org/grants/toxicology-trainee-research-grant) and upload at the end.

Step 1 of 6

Study Title
Project Start Date
Date Format: MM slash DD slash YYYY
Project End Date
Date Format: MM slash DD slash YYYY
Total Budget Requested? (Round to the nearest dollar):

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TRAINEE INFORMATION
Trainee Name and Degree(s)
First Middle Last Degree
Title(s) and Institution
Title(s) Institution
Department/Division
Mailing Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Phone
Fax
Email
Percent Effort Committed to this Study:

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SENIOR INVESTIGATOR INFORMATION
Senior Investigator Name and Degree(s)
First Middle Last Degree
Title(s) and Institution
Title(s) Institution
Mailing Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Phone
Fax
Email
Percent Effort Committed to this Study:

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OTHER INVESTIGATORS
Name
First Last Title(s)
Institution
Email
Percent Effort:
Name
First Last Title(s)
Institution
Email
Percent Effort:
Name
First Last Title(s)
Institution
Email
Percent Effort:
Name
First Last Title(s)
Institution
Email
Percent Effort:

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SPONSORING INSTITUTION
Please note that all funds will be disbursed to the Sponsoring Institution
Institution Name
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Grant Officer Name and Title
First Last Title(s)
Grant Officer Mailing Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Phone
Fax

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Description of proposed project plan on no more than five (5) pages (using 11 point font or larger, 8.5 x 11 inches paper, 1 inch margins, single spacing and single sided pages) under the following headings:
1.Abstract of proposal (limit to one page); 2.Background; 3. Previous work directly related to this project completed by the principal investigators or other personnel involved in the study; 4.Objectives and hypothesis statement(s), if applicable; 5. Rationale and anticipated significance to the selected grant category; 6. Study design and methods to be used including: detailed study procedures, power calculation if applicable, plans for data analysis, and procedures for recruitment and retention of subjects if applicable; 7. Description of the collaborative roles of the study team; 8. Equipment and facilities available; 9. A tabular or graphic month-by-month timetable for completion of the project; and 10. References.
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BIOGRAPHICAL DATA
Provide a four page biosketch for each investigator. In addition to the usual vital statistics, education, professional experience, and publications, each biosketch must include the individual's major research interest and a description of their research experience. The biosketch must be limited to 4 pages and must be submitted in the format provided in the PHS 398 form from the U.S. Department of Health and Human Services. (See www.grants.nih.gov/grants/funding/phs398/biosketchsample.doc.)
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DETAILED BUDGET FOR STATED PROJECT PERIOD
see Section 7 of the PDF application
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CERTIFICATION AND ACCEPTANCE
see Section 9 of the PDF application
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AACT Toxicology Trainee Research Grant

Step 1 of 6

TRAINEE INFORMATION

SENIOR INVESTIGATOR INFORMATION

OTHER INVESTIGATORS

SPONSORING INSTITUTION

Description of proposed project plan on no more than five (5) pages (using 11 point font or larger, 8.5 x 11 inches paper, 1 inch margins, single spacing and single sided pages) under the following headings:

BIOGRAPHICAL DATA

DETAILED BUDGET FOR STATED PROJECT PERIOD

CERTIFICATION AND ACCEPTANCE

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