Prostate Cancer Canada

Clinician Scientist Award Application

For more information visit
www.movember.com

In The News

Collaboration and Innovation in Prostate Cancer Research awarded with $5 Million in Movember Team Grants
Toronto, ON – June 11, 2013 – Prostate Cancer Canada (PCC) is proud to announce the recipients of the inaugural Movember Team Grants. The program promotes collaboration between not only researchers but also institutions, providing a united approach to prostate cancer research. The recipient group will receive $5 million in funding. The 2013 Movember Team Grant has been awarded to Dr. Ralph Buttyan of the Vancouver Prostate Centre (Principal Investigator), who leads a team of 22 Co-Investigators. The title of their research is Tumour Cell Plasticity in Treatment-Resistant Prostate Cancer and their study will focus on targeting aggressive and lethal cancer.

Canadians Celebrate Father’s Day and the Men They Love
15 Communities Set to Increase Awareness of Prostate Cancer this Father’s Day TORONTO, ON – June 5, 2013 – Families across Canada will come together this Father’s Day, Sunday, June 16th, to celebrate the men they love at Prostate Cancer Canada’s Safeway Father’s Day Walk/Run. This annual event sponsored by Canada Safeway will see residents in 15 cities across the country lace up their running shoes to raise funds and awareness for prostate cancer.

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Prostate Cancer Canada
Rising Star in Prostate Cancer Research – 2012

All applicants must carefully READ and FOLLOW the instructions and requirements outlined in the program guidelines and this application form.

NOTE: This application must be completed in one session; you cannot save a partial application.

In addition to this application and attachments, three (3) Letters of Reference and one (1) Signature page must be submitted by the deadline via e-mail to pccresearch@prostatecancer.ca (items 20 and 21 below).

ANY infraction of the guidelines will lead to the truncation or immediate rejection (without appeal) of the application. These regulations have the advantage of being unambiguous for applicants, easily enforceable by staff and/or review panels, and absolutely fair and equitable for all applicants.

Please note: Any documents that you upload in support of your application should be in a PDF or MS Word document. All attached documents, unless otherwise specified, single spaced format is fine.

All uploaded files should each have a unique file name and be named beginning with the applicant's name, followed by the section number. i.e. JoeSmith_14.doc

For further information contact the Prostate Cancer Canada at:
E-mail: josee.guimond@prostatecancer.ca
Telephone: 416-441-2131 ext. 246
Fax: 416-441-2325

* - required field

1. Applicant Information (at time of application)

Last Name: *

First Name: *

Middle Name:

Department: * (Refer to eligibility criteria)

Institution: *

Citizenship: *

2. Current Email Address

Your Primary Email Address: * (To be used for communications related to this award)

3. Current Mailing Address

Department:
(if applicable)

Institution:
(if applicable)

Street Address:

City:

Province/State:

Country:

Postal Code/Zip Code:

Telephone:

() -

Fax:

() -

4. Research Address

Provide the location where the proposed research will be conducted

Department: *

Institution: *

Street Address: * (include street type, floor, room/suite numbers)

City: *

Province: *

Postal Code: *

Telephone: *

() -

Fax:

() -

Email: * (This must be your own address)

5. Research Accounting Information

Provide information for the Financial Officer at the host institution at which this award will be held.

Name of Financial Officer: *

Department: *

Institution: *

Street Address: *

City: *

Province: *

Country: *

Postal Code: *

Telephone: *

() -

Fax:

() -

Email: *

6. Title of Research Project

Title of Research Project: *

7. Keywords

* Provide up to ten (10) keywords that describe the proposed research project.

8. Training Information

Provide information for the Rising Star position to be funded by this award. Funding start date is: January 1, 2013.

Number of years of support requested: *
(maximum three (3) years)

Name a mentor who will advise on the planning, direction and execution of the applicant's research project. The applicant may also nominate co-mentors as appropriate.

Mentor(s) Last Name: *

Mentor(s) First Name: *

Department: *

Institution: *

Additional Mentor Information: (optional)

Upload:

9. Undergraduate Education

Specify EACH undergraduate degree awarded; attach an additional page if necessary.

Degree: *

Start Date (month/year): *

Date Degree Conferred (month/year): *

Institution: *

Additional Undergraduate Degrees: (optional)

Upload:

10. Graduate Education

Specify EACH graduate degree awarded; attach an additional document if necessary.

Degree: *

Start Date (month/year): *

Date Degree Conferred (month/year): *

Institution: *

Supervisor: *

Additional Graduate Degrees (optional):

Upload:

11. Post-Doctoral Training

Specify ALL post-doctoral training; attach an additional document if necessary.

Start Date (month/year):

End Date (month/year):

Institution:

Supervisor:

Addtional Post-Doctoral Training:

Upload:

12. Awards, Prizes, Scholarships and Fellowships (optional)

In a separate document, list ALL awards, prizes, scholarships, and fellowships attained since the start of your undergraduate training; include the following information: Name of Award, Awarding Institution/Sponsor, State Date, End Date, Value/year; there is no limit to the size of document you may attach.

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13. Interruptions

Indicate periods of time greater than one month in which you were not actively engaged in research or clinical training; please also explain any career interruptions in the comment section provided.

14. Research Experience and Training

In a maximum of one double-spaced page, describe your prior research and training and how it relates to your objectives and long-term career plans. Discuss your research efforts to this point in your research career, prior research interests and experience. Provide evidence of your potential to develop into an independent investigator. Indicate dates and names of supervisors, where applicable.

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15. Curriculum Vitae

Attach a brief, three-page personal free form CV. The CV must include information on grants and awards held (sources, type, title, amount/year, duration) and a complete list of relevant publications.

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16. Description of Research Project

Provide the following information on separate pages.

(a) Non-Scientific Summary: Using non-scientific language, provide a one page, double-spaced overview of the proposed research project. This should include a short summary of the aims of the research project, a brief overview of the current knowledge in this research area, a description of the proposed research, and a statement of the how the proposed research is consistent with the goals of PCC:

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(b) Scientific Abstract: Provide a one-page, double-spaced summary of the proposed research, indicating the specific objectives, methodology, intended outcomes, and potential significance to prostate cancer:

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(c) Research Proposal: In a maximum of five (5) pages, must be double-spaced, in Times New Roman 12 pt font, with 1 inch margins all around, summarize the research question, the current state of knowledge in this area, the experimental approach to be taken (including methods and techniques), and the potential significance of the work to prostate cancer. References should be provided, and do not count toward the page limit. Tables and figures may be included but do not count toward page limit.:

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(d) Budget: Attach annual detailed budgets for up to three years with full justification for all budget items relative to the proposed research using the following budget categories: Salaries and Fringe Benefits, Equipment, Materials and Supplies, Services, and Other Expenses:

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17. Reprints/Abstracts

You may append up to three (3) reprints and/or abstracts.

Reprint/Abstract:

Upload:

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18. Statement of Commitment from Host Institution

Provide a statement of commitment from the Dean of Faculty or Research Director confirming (a) an academic or research appointment or pending appointment to a research scientist position, include the start date, teaching load, committee work and any other administrative duties; (b) commitment to the applicant's development into a productive, independent investigator and meeting the requirements of this award; (c) the resources and facilities that will be available to the applicant; (d) how the institutional environment is particularly suited for the development of the applicant's research career and the pursuit of the proposed research plan; (e) the applicant will be able to devote a minimum of 75% of his/her full time effort in developing his/her research program for the duration of the award.

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19. Statement(s) from Research Mentor

Provide a statement from each proposed mentor that includes: 1) information on their research qualifications and previous experience as a research supervisor; 2) a mentoring plan describing the nature of the supervision and mentoring that will occur during the proposed award period and; 3) a plan for transitioning the applicant from the mentored phase of their career to the independent investigator phase during the period of the award. If more than one mentor is proposed, they should clearly describe how they will coordinate mentoring of the applicant. (If more than one mentor, scan all statements together into one document to upload). Limit: one single-spaced page per mentor.

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20. Letters of Reference (3 required)

Applicants must arrange for three letters of reference to be submitted directly from the referees in support of the applicant and providing evidence that the applicant has a high potential for becoming an independent investigator. All letters of reference should be signed and sent directly from the referee to pccresearch@prostatecancer.ca by the submission deadline. The mentor(s) may also submit letters of reference; however, these will be considered independently from the required reference letters.

21. Signature Page

Applicants must download and complete the Signature Page. Once completed, the signature page must be sent directly to pccresearch@prostatecancer.ca by the submission deadline.

Please review your form to ensure its completion before clicking the SUBMIT button.

If you are having difficulty submitting your Rising Star application through the site –
please send an email with all appropriate content and attachments
required for the application by the deadline of 11:59 pm November 1, 2012 to
pccresearch@prostatecancer.ca and copy josee.guimond@prostatecancer.ca.