Fixel Clinical Research Fellowship Award Application Page Clinical Research Fellowship Funding Award Program Application This Application Must be Submitted by an Official UF Fellowship Director. For ALS Pre- or Post-Doctoral Applicants, Submission Must be Made by the Research Mentor.Are You a Fixel Member?(Required) Yes No Fellowship Director or Research Mentor UF ID(Required)Name of Fellowship Director or Research Mentor(Required)Fellowship Director or Research Mentor Email(Required)Fellowship Director or Research Mentor's Department Name(Required)Department Fiscal Contact(Required)Fellow or Pre-/Post-Doctoral Investigator InformationIf a fellow or pre-/post-doctoral investigator has not yet been identified, please enter “N/A” for the fields below. Support may still be proposed with a structured educational and research plan.Please Select Your Applicant's Track Fellow (MD or DO) Pre-/Post-Doctoral Investigator Conducting Translational ALS Research Name(Required)Department(Required)Email(Required)Training Level (select one)(Required)PGY 5PGY 6PGY 7Pre-Doctoral / Post-DoctoralWhich of the following Fixel Disease Populations Will the Position Serve?(Required) ALS and other related neuromuscular disorders Alzheimer’s, dementia and other related memory disorders Concussion and other types of traumatic brain injury Multiple Sclerosis Parkinson’s, dystonia and other related movement disorders Total Dollars Requested For FTE Support (Salary + Fringe)(Required)Additional Discretionary Dollars Requested (optional, up to $2,500.00)Department ID (For Funding Purposes)(Required) Required Application Materials All applications must include: For clinical fellows (MD/DO): Proof of GME approval of the fellowship. A letter of support from the fellowship director or research mentor. A chart detailing milestones and timeline for the fellowship or research plan and task completion (clinical and research, if applicable). A clear distinction of the amount of clinical time vs. research time (if applicable). Include a paragraph on future career plans if the fellow or pre-/post-doctoral investigator has been identified. Second- or third-year fellowship applicants must also include a one-page NIH-style specific aims page for the research project. Budget: Provide the total amount requested and budget justification (half page maximum) minus existing departmental, philanthropic, and industry funds. The existing should be listed to show partnerships for individual fellows or investigators. Budgets that include contributions for partnership funding will be given priority. Upload Application Here(Required)Max. file size: 125 MB.
