Application for the WDS Academic Research Grant Program

WOMEN’S DERMATOLOGIC SOCIETY
2009 WDS Academic Research Grant Application
Deadline for 2009 Awards: November 30, 2008

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APPLICANT INFORMATION:

Name:
eMail:
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)

REQUIRED APPLICATION MATERIALS:

Refer to criteria listed below to be sure you are eligible for consideration:

Guidelines and Criteria for Selection

Resident in an accredited dermatology training program -or--
Young dermatologist who is board-certified or board-eligible and who is within the first three years after completing post-graduate training
Demonstrates a strong commitment to skin research, either clinical or basic science
Appropriate training in biomedical research or mentor available for instruction in this area (letter of commitment from the mentor must accompany application)
Strong institutional commitment for the individual’s career development (letter of commitment from the academic institution must accompany application)
Preference for residents and young dermatologists with no other sources of funding
A summary of research results must be submitted at the end of the project for publication in the WDS newsletter
Research grant awards must be to used within two years of receipt

ADDITIONAL INSTRUCTIONS TO APPLY:

Assemble the following items, in the order presented, for your application package. Refer to the grant 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, and one photocopy of all materials (except the photo and the proposed budget) to the WDS for consideration.

Research Award Application Form (Done with this form)
Applicant Biographical Sketch
Mentor’s Biographical Sketch
Summary of Career Goals (1 page)
Research Proposal (No more than 5 pages)
Letter of Support from Department Chair
Letter of Support from Mentor
One Additional Letter of Support
Layman’s Statement (1 page)
Head and Shoulder Photo in Electronic Format
Proposed Budget

ADDITIONAL COMMENTS:

Send the required materials, items #2 - #11 (listed above) to:
Women’s Dermatologic Society-
575 Market Street, Suite 2125
San Francisco, CA 94105

Toll-Free: 1-877-WDS-ROSE
PHONE: (415) 764-4925 | FAX: (415) 764-4933

ADDITIONAL COMMENTS:

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This grant program generously sponsored by: OrthoNeutrogena