RESEARCH FOCUS: BIOMARKERS AND PHENOTYPING FOR RETINAL DISEASE

PROGRESSION

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Letter of Intent2019 Award Cycle

RESEARCH AWARD

ContentsINSTRUCTIONS..............................................................................................................................................3

GOAP CONTACT............................................................................................................................................3

RESUBMISSION INSTRUCTIONS.................................................................................................................4

HOW DID YOU HEAR ABOUT THE PROGRAM?..........................................................................................4

ELIGABILITY FOR AWARD............................................................................................................................5

APPLICANT DETAILS.....................................................................................................................................5

QUALIFICATIONS........................................................................................................................................6

RESEARCH AWARD ABSTRACT..................................................................................................................7

RESEARCH PROJECT OUTLINE...............................................................................................................7

PROJECT DETAILS.....................................................................................................................................7

FUNDING REQUESTED..............................................................................................................................8

DECLARATIONS.............................................................................................................................................8

FOR OFFICIAL USE ONLYNAME Click or tap here to enter text.NUMBER Click or tap here to enter text.SIGNATURES ☐

WORD COUNTS ☐

APPLICANT REAPPLYING Choose an item.

ALL SECTIONS COMPLETED ☐

CHECKED BY Click or tap here to enter text.

DISCLAIMER: The Global Ophthalmology Award Program (GOAP) is fully sponsored by Bayer PLC, with the main purpose is to encourage young ophthalmologists and aspiring clinical scientists to pursue a career as retinal specialists. The Grant Awards Review Committee (GRAC) evaluates and ranks the GOAP applications and convenes once per year to finalize the list of awardees. Bayer organizes the process but is not involved in the application evaluation process, nor in the selection of awardees.

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INSTRUCTIONS

Please carefully read the guide to submitting an application on the GOAP website before proceeding with your application, paying particular attention to the following:• Eligible projects should have a duration of one year. A maximum budget of up to US $50,000

is available for the majority of cases

• Applicants must complete all sections of this form, including stating wordcounts where required. If a section does not apply to you, please write or choose ‘not applicable’ (N/A)

Priority will be given to projects relating to the 2019 research focus of biomarkers and phenotyping for retinal disease progression

• Two applications from the same group will not be accepted, regardless of whether they are applying for the different award categories (i.e. Research Award/Fellowship Award)

• PhD projects will not be considered for this award

• Applicants who are members of a commercial entity/company will not be considered for this award

• Upon completion of this proposal form, please email it to the GOAP Program Secretariat (managed by the agency ApotheCom on behalf of Bayer PLC, Switzerland): GOAP@bayer.com

• If you are resubmitting an application, please follow the instructions below

GOAP CONTACT For any questions, please refer to the GOAP secretariat:

Bernadette Stansfield GOAP@bayer.com +44 (0) 207 340 6636

DISCLAIMER: The Global Ophthalmology Award Program (GOAP) is fully sponsored by Bayer PLC, with the main purpose is to encourage young ophthalmologists and aspiring clinical scientists to pursue a career as retinal specialists. The Grant Awards Review Committee (GRAC) evaluates and ranks the GOAP applications and convenes once per year to finalize the list of awardees. Bayer organizes the process but is not involved in the application evaluation process, nor in the selection of awardees.

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RESUBMISSION INSTRUCTIONSIf you are submitting an application that was previously submitted to GOAP, please tick the box below and select the year that you last submitted the application:

I am resubmitting an application ☐

I previously applied for funding from GOAP in

Choose an item.

In addition, please attach a letter covering the following points:

Describe how you have addressed each feedback point previously provided by the Program Secretariat

If a feedback point has not been addressed, please explain why this is the case

Please tick the box to confirm that you have attached the letter

☐

How did you hear about the program? Choose an item.

HOW DID YOU HEAR ABOUT THE PROGRAM?If other, please state how you found out about GOAP

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DISCLAIMER: The Global Ophthalmology Award Program (GOAP) is fully sponsored by Bayer PLC, with the main purpose is to encourage young ophthalmologists and aspiring clinical scientists to pursue a career as retinal specialists. The Grant Awards Review Committee (GRAC) evaluates and ranks the GOAP applications and convenes once per year to finalize the list of awardees. Bayer organizes the process but is not involved in the application evaluation process, nor in the selection of awardees.

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ELIGABILITY FOR AWARDPlease complete the below section to confirm your eligibility for this award.

Have you qualified as an ophthalmology specialist within the past 10 years or currently training to become an ophthalmology specialist or received a PhD qualification within the past 10 years?

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Please state the number of vision science-related publications (PubMed-indexed) you have (co-)authored to date.

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APPLICANT DETAILSApplicant informationTitle Click or tap here to

enter text.Full name Click or tap here to

enter text.Phone Click or tap here to

enter text.Full address Click or tap here to

enter text.Email Click or tap here to

enter text.Employer institute informationYour current (home) institution:

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Country Click or tap here to enter text.

Your current position within this institution/organization:

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Name of institute/employer to which funding will be awarded

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Type Choose an item.

Full address Click or tap here to enter text.

Institutional Profile File number: (Write not applicable if unknown)

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DISCLAIMER: The Global Ophthalmology Award Program (GOAP) is fully sponsored by Bayer PLC, with the main purpose is to encourage young ophthalmologists and aspiring clinical scientists to pursue a career as retinal specialists. The Grant Awards Review Committee (GRAC) evaluates and ranks the GOAP applications and convenes once per year to finalize the list of awardees. Bayer organizes the process but is not involved in the application evaluation process, nor in the selection of awardees.

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QUALIFICATIONS Education/training:Please provide details of your professional education in the relevant spaces provided below. Include baccalaureate or other initial professional education (such as nursing), as well as any postdoctoral training.

Institution:(Please include location)

Qualification obtained: Years:(e.g. 1999–2002)

Comments:(e.g. field of study)

Positions and honours:In chronological order, please list any positions held prior to your current position. Provide details of any honours obtained, including present memberships on any advisory committees.(MAXIMUM 10 EXAMPLES)

Selected publications:In chronological order, please provide a list of your publications. Do not include publications submitted or in preparation.

DISCLAIMER: The Global Ophthalmology Award Program (GOAP) is fully sponsored by Bayer PLC, with the main purpose is to encourage young ophthalmologists and aspiring clinical scientists to pursue a career as retinal specialists. The Grant Awards Review Committee (GRAC) evaluates and ranks the GOAP applications and convenes once per year to finalize the list of awardees. Bayer organizes the process but is not involved in the application evaluation process, nor in the selection of awardees.

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(MAXIMUM 10 EXAMPLES)

RESEARCH AWARD ABSTRACTTitle of proposed project (Maximum 100 characters, including spaces)

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Duration of project Choose an item.

RESEARCH PROJECT OUTLINE RESEARCH SECTION (500 words)

Describe the rationale for your proposed project and the justification for the proposed methods, including power calculations for justification of your sample sizes, where appropriate.Include any potential pitfalls of the methods and suggest alternative strategies.Describe any future work anticipated from completion of this project, especially with regard to care of patients with retinal disorders.If necessary, please include a reference list, which does not contribute towards the word limit.

Please enter research project outline here: Click or tap here to enter text.

Please specify the word count (max. 500 words): Click or tap here to enter text.

PROJECT DETAILSPlease state the percentage of your time that will be dedicated to this project:

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Please provide the name and title of the principal investigator:

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Please provide the name(s) and title(s) of any co-investigators:

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DISCLAIMER: The Global Ophthalmology Award Program (GOAP) is fully sponsored by Bayer PLC, with the main purpose is to encourage young ophthalmologists and aspiring clinical scientists to pursue a career as retinal specialists. The Grant Awards Review Committee (GRAC) evaluates and ranks the GOAP applications and convenes once per year to finalize the list of awardees. Bayer organizes the process but is not involved in the application evaluation process, nor in the selection of awardees.

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Is this research ongoing? Choose an item.

Has this work received ethics approval? Choose an item.

Has funding been provided from other sources?

Choose an item.(If yes, please provide details in the space below)Click or tap here to enter text.

FUNDING REQUESTEDA maximum budget of up to US $50,000 is available for the majority of cases. Additional funding will be considered, but must be justified. Budgets should be realistic and appropriate to the scope of work being proposed. Payment will be made to the awardee’s institution only.

US $ Click or tap here to enter text.Please write the full amount in words in the space provided below:

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DECLARATIONSAPPLICANT ASSURANCE

I certify that the statements herein are true, complete and accurate to the best of my knowledge.

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Application signature

PRINCIPAL INVESTIGATOR/PROGRAM DIRECTOR ASSURANCE

I certify that the statements herein are true, complete and accurate to the best of my knowledge.

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Principle Investigator/Program Director full name and signature

DISCLAIMER: The Global Ophthalmology Award Program (GOAP) is fully sponsored by Bayer PLC, with the main purpose is to encourage young ophthalmologists and aspiring clinical scientists to pursue a career as retinal specialists. The Grant Awards Review Committee (GRAC) evaluates and ranks the GOAP applications and convenes once per year to finalize the list of awardees. Bayer organizes the process but is not involved in the application evaluation process, nor in the selection of awardees.

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