Application and Nomination for
Doris Duke Fund to Retain Clinical Scientists
Instructions:
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Applicants must be physicians with some clinical responsibilities who 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
Completed applications are due at 5:00 PM on May 23, 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.
Application Sections
1. Candidate’s NIH-formatted biosketch (new format). To be completed by candidate.
2. Statement of need, describing role as a caregiver and how the funds will help the candidate’s research.
Maximum length is one page. To be completed by candidate.
3. Career Development and Mentorship Plan. The applicant should describe his/her career plans including a path
to independence as well as the mentorship plan. Maximum length is one page. To be completed by candidate.
4. Research plan for the project to be undertaken, using the standard NIH format (Summary/Abstract, Specific
Aims, Background/Significance/Preliminary Data and Approach/Research Design and Methods). Maximum
length is 3 pages plus references. To be completed by candidate
5. References (as needed). To be completed by candidate
6. 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.
7. 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.
8. Detailed budget and justification using the included budget template. Funds ($25,000 to $50,000) can be
requested to supplement a currently funded project for a period of one year. Funds may be used for funding for
an assistant such as a statistician, a study coordinator, a grant writer or a laboratory technician or for enabling
the applicant to reduce clinical effort and gain protected time for research. The funds cannot be used to add
either additional research aims or new projects or to duplicate existing funding. This section is to be completed
by applicant in conjunction with the applicant’s business office.
9. Letters of support from the candidate’s mentors (maximum of 1 page each for letters). To be completed by
mentors.
10. 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
Part 2
Part 3
Part 4
Part 5
Part 6
Part 7
Part 8a
Part 8b
Part 9
Part 10
Candidate’s NIH-formatted biosketch (new format)
Statement of need, describing role as a caregiver and how the
funds will help the research
Career Development and Mentorship Plan, including path to
independence
Research Plan (must include Project Abstract/Summary,
Specific Aims, Significance Background/Preliminary Data and
Approach)
References
Other Support
Other Support Departmental Administration
Detailed Budget
Budget Justification
Letters of Support from Candidate’s mentors
A copy of the current appointment letter appointing the
candidate to faculty status within the department.
Page Limit
Up to 5
Up to 1 page
Up to 1 pages
Up to 3 pages
As needed
As needed
As needed
Up to 2 pages
As needed
Up to 1 Page each
Insert 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
Statement of Need
Statement of need, describing role as a caregiver and how the funds will help the research (maximum of 1
page).
Candidate Development and Mentorship Plan. The applicant should describe his/her career plans including a
path to independence as well as the mentorship plan.
Research Plan (Limited to 3 pages)
Project Summary/Abstract:
Specific Aims:
Significance/Background/Preliminary Data:
Approach/Methods:
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 August 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 Care
10%- Departmental GA funding
50%- 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 PERIOD
DIRECT COSTS ONLY
FROM
THROUGH
8/01/17
7/31/2018
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
NAME
ROLE ON
PROJECT
Cal.
Mnths
Acad.
Mnths
Summer
Mnths
INST.BASE
SALARY
SALARY
REQUESTED
FRINGE
BENEFITS
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 using the included budget template. Funds ($25,000 to $50,000) can be
requested to supplement a currently funded project for a period of one year. Funds may be used for funding
for an assistant such as a statistician, a study coordinator, a grant writer or a laboratory technician or for
enabling the applicant to reduce clinical effort and gain protected time for research. The funds cannot be
used to add either additional research aims or new projects or to duplicate existing funding. Please use an
additional page if needed.
Letters of Support
1. Letter of support from candidate mentors (limit 1 page each)
Appointment Letter
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.
FOT Code List