GRANT APPLICATION
Please Select a Fund
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Vince Lombardi Cancer Foundation (Supporting efforts for all cancer types)
Starr Children's Fund (Supporting efforts for pediatric cancer)
Type of Grant Request
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Basic science research
Clinical research
Cancer detection and/or prevention
Patient/Clinician support
Other
Type of Application
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New
Resubmission
Renewal
Revision
Health Care Institution or Organization Name
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Institution/Organization's Address
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Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Institution Website
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Institution's Website
Full Name and Title of Main Application Contact
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EX: John Smith, Head of Programming
E-mail and Phone Number for Main Application Contact
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EX: JohnSmith@abcd.com / (334)321-1234
Total Oncology Patients Treated Annually
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Number of Patients Annually
Type of Oncology Patients That Will Be Affected By Funding
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# of Oncology Patient That Will Be Affected By This Funding
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Annual Revenue
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Institution's Annual Revenue/Income
About This Project
Descriptive Title of Project
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Please provide a brief description of your project [Limit to 100 words]
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Amount of Funding Requested
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Please upload a project synopsis/summary of this project that includes the following: A) Potential outcomes of proposed research or program B) Proposed project start date and timeline C) Goals and objectives of project and parameters to measure if the goals have been reached
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Please upload a high-level budget of how the grant funds will be used that includes the following if applicable: A) Equipment B) Salaries C) Statistical Support and anything else that funding will be used for
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Principle Investigators and Collaborators
Project Director / Principle Investigator
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First Name
Last Name
Suffix
Project Director Position / Title
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Project Director Email
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Project Director Phone Number
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Area Code
Phone Number
Personal Statement
Optional
CV for Project Director
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Lead Collaborator
First Name
Last Name
Lead Collaborator Email
example@example.com
Lead Collaborator Phone Number
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Area Code
Phone Number
CV for Lead Collaborator
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CV for Additional Investigators/Co-Investigators
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Optional
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OPTIONAL: Please upload a Biosketch that describes why you are well-suited for your role in this project. Relevant factors may include aspects of your training, previous experimental work on this topic or related topics, your technical expertise, your collaborators or scientific environment and/or your past performance in this or related fields.
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Project Details
Personnel Justification
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Who will be contributing to this project and why
Proposed Project Start Date
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Month
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Day
Year
Date
Proposed Project End Date
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Month
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Day
Year
Date
Bibliography & References Cited
Have you applied for or received any prior funding for this project? Please explain below:
Current and previous funding
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