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)

Other Funding Support for this Project

Please list each funding source and amount for each source

Any additonal notes or comments about your budget

Email

This field is for validation purposes and should be left unchanged.

Discovery Grant Submission Form

Submitting Organization

Checks Made Payable To

Send Award Notice To

Year 1 Budget Proposal and Justification

Year 2 Budget