sample preliminary information form (pdf) - amfAR

INSTRUCTIONS
Preliminary Information Form
Mathilde Krim Fellowships in Basic Biomedical Research
Submission of this form does not obligate the applicant to submit an LOI,
Please read the RFP carefully before completing and submitting this form to ensure that you are a qualified applicant from
an eligible research institution.
Section 1: Please enter:
• The name of the institution that would be the grant recipient 1 and the address of the institution’s main location.
Section 2: Please enter:
• The principal investigator’s name(given name / surname)
• Doctoral-level degrees (e.g., Ph.D., M.D., D.D.S, Sc.D., M.B.B.S – not “Dr.”)
• The title of your position (e.g., Assistant Professor, Senior Scientist, Physician) at the institution that would be
the grant recipient.
• The e-mail address where you can be reached at the present time. You may enter more than one e-mail
address by inserting a semi-colon between addresses.
• The telephone number where you can be reached at the present time.
• The principal investigator’s department at the institution listed above.
• Fellowship applicants are to enter the mentor’s name, degree and title. Mentors are to be experienced,
faculty-level (associate professor or equivalent) HIV/AIDS researchers.
• The month and year that your post-doctorate degree was conferred.
• The number of months you have been a post-doc in HIV/AIDS on January 1, 2010.
See the RFP for information about fellow and mentor qualifications.
Section 3: Bear in mind that minor differences between the information on this form and a submitted LOI are allowed. If
you are contemplating proposals that pose markedly different research questions or are in distinctly different areas of
research, please submit a separate form for each proposal. Should you change your mind about the content of a
proposal, please contact the amfAR’s grants administration department by e-mail to grantapps@amfar.org.
The following information is required from all applicants:
• The title of your project. Please limit the title to no more than 75 characters and spaces.
• Please enter 10 keywords or phrases that describe the proposed research.
• Using the drop down menu, select the topic area that corresponds most closely to the proposal that you plan
to submit. Topics areas are:
1. Immunology
2. Infections or cancers associated with HIV infection
3. Molecular biology
4. Pathogenesis
5. Prevention (including vaccines, microbicides or other biomedical interventions)
6. Reservoirs, latency and viral eradication
7. Therapeutics
8. Virology
• Once again, using the drop down menu please to identify whether your proposal is most closely relevant to
the treatment or prevention of HIV infection.
• Please provide the names and institutional affiliations of five scientists who are not current collaborators and
would be well qualified to review your research proposal.
1 amfAR grants and fellowship grants are awarded to nonprofit institutions (or non-U.S. equivalents) only; they are not awarded to individuals or to forprofit
entities. If requested, documentation of nonprofit status must be provided prior to the activation of a grant.