WDS Academic Research Awards Program Application

WDS Academic Research Awards Program Application

WOMEN’S DERMATOLOGIC SOCIETY
2011 WDS Academic Research Awards Program Application
Application Deadline: October 7, 2011

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APPLICANT INFORMATION:

Name:
eMail:
Institution:
Address 1:
Address 2:
City:
State:
Zip:
Country:
Telephone:
Fax:

TITLE OF RESEARCH PROJECT:

Title of Research Project
(Do not exceed 100 characters, including spaces and punctuation:

MENTOR & DEPARTMENT CHAIR INFORMATION:

Mentor Name:
Mentor eMail:
(PLEASE NOTE: You are responsible for accuracy of the Mentor eMail address provided above)
Department Chair Name:
Department Chair eMail:
(PLEASE NOTE: You are responsible for accuracy of the Department Chair eMail address provided above)

APPLICANT ELIGIBILITY:

Awards will be awarded on the basis of scientific merit and the anticipated impact of the project on the field of dermatology. Preference will be given to candidates who have demonstrated a clear intention of pursuing a career in academic medicine. Candidates with no other sources of funding may receive preferential consideration.

REQUIRED APPLICATION MATERIALS:

Assemble the following items, in the order presented, for your application package. Refer to the award requirements criteria for selection. Number the pages of your application continuously. Once complete, place this form on top of all your application materials. Submit all items listed below, one original hardcopy (except photo) and one electronic copy (email or cd) to the WDS for consideration.

Research Award Application Form (Done with this form)
Applicant’s Biographical Sketch
Mentor’s Biographical Sketch
Layman’s Statement (1 page)
Research Proposal (No more than 6 pages including Budget portion)
Proposed Budget
Letter of Support from Department Chair
Letter of Support from Mentor
Copies of Relevant Publications (maximum of 2)
Head and Shoulder Photo in Electronic Format

ADDITIONAL COMMENTS:

Send the required materials, items #2 - #11 (listed above) to:
WDS Academic Research Awards Program-
Women’s Dermatologic Society
700 N Fairfax Street, Suite 510
Alexandria, VA 22314

Toll-Free: 1-877-WDS-ROSE
PHONE: (571) 527-3115 | FAX: (571) 527-3105

ADDITIONAL COMMENTS:

Application deadline: October 7, 2011

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Generous sponsorship support has been provided by Ortho Dermatologics (formerly OrthoNeutrogena)