Discovery Grant Form

Submitting Organization

Institution Name(Required)

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Proposed Work or Research(Required)

Total Amount Requested In US $(Required)

Proposed Duration(Required)

Desired Starting Date(Required)

Ending Date

Name of Principal Investigator(Required)

First Last

Department

Phone

Email(Required)

Name of Institutional Contact – Grants/Sponsored Research Division(Required)

First Last

Phone

Checks Made Payable To

Institution Name(Required)

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Send Award Notice To

Institution(Required)

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

ABSTRACT AND SUMMARY OF PROPOSED WORK (limit 375 words)(Required)

SPECIFIC AIMS AND HYPOTHESES(Required)

BACKGROUND, SIGNIFICANCE AND PRELIMINARY DATA(Required)

Potential Impact on AS or Dup15q Research and/or on the Care/Treatment of Those with AS or Dup15q(Required)

up to 250 words

CITED REFERENCES

Year 1 Budget Proposal and Justification

Year 1 Personal Expenses and Costs

Please list each expense and its cost

Year 1 Supplies and Associated Costs

Please list each expense and its cost

Year 1 Tests or Other Expenses and Associated Costs

Please list each expense and its associated cost

Total Travel Expenses for Year 1 and Year 2 (not to exceed $1,500 USD)

Please enter a number less than or equal to 1500.00.

Year 1 Amount of Indirect Costs (limited to 10%)

Total Cost of Year 1

Year 2 Budget

Year 2 Personal Expenses and Costs

Please list each expense and its associated cost

Year 2 Supplies and Costs

Please list each expense and its associated cost

Year 2 Tests or Other Expenses and Costs

Please list each expense and its cost

Year 2 Indirect costs (limited to 10%)

Total Cost of Entire Project (Year 1 & 2)(Required)

Total Ladder Learning Network Support (Requested for this Project) (Year 1 & 2)(Required)

Discovery Grant Submission Form

Submitting Organization

Checks Made Payable To

Send Award Notice To

Year 1 Budget Proposal and Justification

Year 2 Budget