THE LALOR FOUNDATION, INC.

C/O GRANTS MANAGEMENT ASSOCIATES

77 SUMMER STREET, 8TH FLOOR

BOSTON, MASSACHUSETTS 02110-1006 USA

(617) 426-7080 FAX: (617) 426-7087

WWW.LALORFOUND.ORG

 

APPLICATION FOR SUPPORT OF RESEARCH PROJECT AND SPONSORED FELLOWSHIP

_____________________________________________________________________________________

SUMMARY DATA

Proposed Fellow (Name and Degrees):

_____________________________________________________________________________________

Supervisor, Advisor, or Principal Investigator (Name, Degrees and Title):

_____________________________________________________________________________________

Institution:

_____________________________________________________________________________________

Work is to begin (Month, day, year):______________ and continue for_____ (maximum of 12) months.

It will occupy ______% of the Fellow's time. Amount requested: $____________.

Project Title:

_____________________________________________________________________________________

_____________________________________________________________________________________

_____________________________________________________________________________________

Abstract of the project and its relevance to The Lalor Foundation's focus: (Limit length to fit within this space.)













_____________________________________________________________________________________

Application - Page 1 (Cover Sheet)

THE LALOR FOUNDATION, INC.

APPLICATION - Page 2

GENERAL

The following institution

________________________________________________________________________

hereby applies to The Lalor Foundation for support of a research project entitled:

________________________________________________________________________

________________________________________________________________________

________________________________________________________________________

to be conducted in the (Department, Institute or other unit):

________________________________________________________________________

of which the Director is (Name, present title and email address):

________________________________________________________________________

This institution will designate (Name, present title and email address):

________________________________________________________________________

presently at the (Present laboratory or other division):

________________________________________________________________________

of the (Present university or institution):

________________________________________________________________________

as its candidate for appointment to a Lalor Fellowship for the conduct of the research under this project.
The supervisor, advisor, or Principal Investigator on this project will be (Name, title, mail address, email address and telephone number):

________________________________________________________________________

________________________________________________________________________

Research on this project will occupy _____% of the time of the fellowship holder, whose other activities will be (Indicate their character, relationship to the proposed project, amount of remuneration to the fellowship holder and from whom):

________________________________________________________________________

________________________________________________________________________

________________________________________________________________________

________________________________________________________________________

 

 

THE LALOR FOUNDATION, INC.
APPLICATION - Page 3

BUDGET

State below the total amount requested for the project, with dollar distribution into major component items, such as payments to the Fellowship holder, animal and laboratory expense, major equipment, apparatus and supplies, institutional overhead (in no case to exceed 8%), and other expenses.

Any sum granted by The Lalor Foundation on this project is its entire commitment hereunder. If other support is contemplated for this project, state the sources, how much and other pertinent details.










REFERENCES

Please give names, official positions and addresses of the two independent authorities who will express expert opinions on the originality, practicability and value of the proposed project; and similarly, an individual who will provide a reference concerning the postdoctoral nominee. The individuals named should write directly to The Lalor Foundation regarding these pertinent aspects. All statements are held in strict confidence. Please provide each project reviewer with a copy of The Lalor Foundation’s guidelines for review letters, which can be found at the end of the Application Instructions.

IT IS THE RESPONSIBILITY OF THE APPLICANT TO HAVE REFERENCE AND REVIEW LETTERS SENT DIRECTLY TO THE FOUNDATION. THEY SHOULD BE RECEIVED BY THE FOUNDATION NO LATER THAN JANUARY 13, 2006.






THE LALOR FOUNDATION, INC.

APPLICATION - Page 4

 

OBLIGATIONS OF THE GRANTEE

 

The applicant institution, if awarded a grant, agrees to the following:

 

To repay any portion of the amount granted which is not used for the purposes of the grant;

To submit full and complete annual reports on the matter in which the funds are spent and the progress made in accomplishing the purposes of the grant;

To maintain records of the receipts and expenditures and to make its books and records available to The Lalor Foundation at reasonable times;

Not to use any of the funds granted -

To carry on propaganda, or otherwise to attempt, to influence legislation (within the meaning of section 4945(d)(1) of the U.S. Internal Revenue Code);

To influence the outcome of any specific public election, or to carry on, directly or indirectly, and voter registration drive (within the meaning of section 4945d(d)(2) of the U.S. Internal Revenue Code);

To make any grant which does not comply with the requirements of section 4945(d)(3) or (4) of the U.S. Internal Revenue Code; or

To undertake any activity for any purpose other than one that is charitable, scientific or educational.

To maintain funds awarded by the Foundation in a separate fund (which may be a separate bank account or a separate bookkeeping account) maintained for charitable purposes.

Appendices A, B and C as described in The Lalor Foundation’s Application Instructions are attached to, and form a part of, this Application.

 

SIGNATURE: _______________________________________________ DATE: _________________

TITLE: ______________________________________________________________________________

FOR (Name of institution): ______________________________________________________________

 

 

THE LALOR FOUNDATION, INC.

APPLICATION INSTRUCTIONS

The application form consists of 4 pages, which should be filled out completely and submitted with the 3 Appendices described below. Please see the Foundation's printed Announcement or website home page (WWW.LALORFOUND.ORG) for eligibility details.

SPECIFICATIONS CONCERNING APPLICATIONS

1. The application and all material submitted should be typewritten on 8 1/2" x 11" or A4 paper. Every document submitted should bear an identifying mark in the upper right hand corner.

2. The signed, completed application form and all supporting information which the applicant's institution wishes to have considered should be received by the Foundation not later than January 13, 2006.

3. Applications and accompanying documents should be addressed to The Lalor Foundation, Inc., c/o Grants Management Associates, 77 Summer Street, 8th Floor, Boston, MA 02110-1006 USA.

 

APPENDICES
The application is to be accompanied by three appendices as follows:

Appendix A - Background and Plan of Work for the Project (5 to 7 pages only)
The appendix is to set forth:

a) Name of Institution and laboratory where the work will be done.
b) Title of the project as listed on pages 1 and 2.
c) Plan of work for the project describing concisely the present state of knowledge regarding the problem, the scope, specific objectives and importance of the work which would be accomplished during the period. Please outline in what fashion this research can potentially be applied to the regulation of human fertility or a method of birth control. Such information may be helpful in making a choice between applications which are equally attractive from a purely scientific point of view.

Appendix B - Curricula Vitae
The appendix is to set forth:

a) A summary signed by the fellowship nominee giving his/her name, date of birth and citizenship; education, degrees received with locations and dates, graduate degrees achieved, names of principal professor, titles of dissertations and under whom, honors and awards achieved; positions held, and principal accomplishments. Principal duties in present position, percentage distribution of effort into teaching, research, writing, counseling, administrative and external activities. Membership in scientific or allied societies. Lists of publications with titles, names of co-authors, journals and dates.
b) The C.V. of the Supervisor, Advisor, or Principal Investigator. It should be the standard 'short form' and must be kept to 4 or fewer pages.

Appendix C - Tax status and other approvals
The Appendix is to set forth information concerning the institution’s eligibility to receive grants under U.S. tax laws and approvals of the project by reviewing bodies. See and complete the attached form of Appendix C.

 

THE LALOR FOUNDATION, INC.

APPENDIX C TO APPLICATION

The institution represents that it is (check one):

£ (a) A private domestic or foreign organization (a corporation or a trust) that has been determined by the Internal Revenue Service as not being a private foundation under the terms of paragraph (1), (2) or (3) of section 509(a) of the U.S. Internal Revenue Code or as being exempt operating foundation as defined in section 4940(d)(2) of the U.S. Internal Revenue Code; that attached to this Appendix is a true copy of a letter of the Internal Revenue Service dated ________________ by which the Internal Revenue Service made or affirmed such determination; that such determination has not been modified or revoked; and that there are no proceedings, conditions or circumstances known to the institution that could lead to the revocation of such determination.

£ (b) An agency or instrumentality of a federal, state or local public agency in the United States or the District of Columbia.

£ (c) An agency or instrumentality of a foreign government, namely, the government of ____________________.

£ (d) A foreign private organization (a corporation or a trust) that has not received a determination from the Internal Revenue Service as referenced in subparagraph (a) above but is organized under the laws of the following country, namely _____________________, and is operated for charitable, educational and scientific purposes; and that attached to this Appendix is a true, current and complete copy (with translations into English if necessary) of the charter or other organizing documents for the organization.

£ (e) A public international organization entitled to enjoy certain privileges, exemptions and immunities under section 288 of Title 22 of the U.S. Code.

Note: If the institution checks box (a) or box (d) above, it must attach a copy of the document or documents referenced.

2. The institution represents that the project has been reviewed and approved by the following bodies: (e.g. Animal Investigation Committee)

 

THE LALOR FOUNDATION, INC.

C/O GRANTS MANAGEMENT ASSOCIATES

77 SUMMER STREET, 8TH FLOOR

BOSTON, MASSACHUSETTS 02110-1006

U.S.A.

(617) 426-7080, FAX: (617) 426-7087

 WWW.LALORFOUND.ORG

 

Guidelines for Confidential Letter of Review for Postdoctoral Fellowship

 

 

Name of Candidate for Fellowship: _______________________ Name of Principal Investigator: _____________________

 

 

Thank you for agreeing to serve as an expert reviewer for this postdoctoral fellowship application to the Lalor Foundation. In order to ensure that we have comparable information for each applicant, we ask that you address the following points in your review:

1. State your area of expertise in reproductive biology

2. Assess the quality of the candidate applying for the fellowship

3. Assess the scientific quality of the proposal, list strengths as well as weaknesses

4. Comment on the Principal Investigator’s laboratory