2024 Krainin Memorial Research Grant Application

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***STOP!***

Only use this form to start a NEW application.

If you've already started an application, use the link in the top right-hand corner to resume your application. Click "Next Page" to find and resume where you left off.

Welcome!

Please review the Instructions to Applicants for National Kidney Foundation Research Grants before completing this application.

All applications and supplementary materials are due by September 30, 2024.

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Project Information

Title of Research Project

Please do not exceed 255 characters, including spaces.

This Project Proposal is:

NewA Renewal

Please describe in the space provided below, the relevance of the proposed project to the research agenda of the NKF, explaining, if appropriate, the specific research recommendation(s) from the KDOQI Clinical Practice Guidelines, Commentaries, or Controversies Reports that the proposal addresses. (A complete listing of KDOQI Research Recommendations is available here)

Please provide a short list of issues that the proposed research addresses:

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About Applicant

Applicant's Highest Degree:

Citizenship or Visa Status

Prior and/or Current NKF Support (Individual or Program)

YesNo

Present Mailing Address

Address Line 1

Address Line 2

City

State/Province

Postal Code

Country

Is your Permanent Address the same as your Present Address?

YesNo

Permanent Mailing Address

Address Line 1

Address Line 2

City

State/Province

Postal Code

Country

Phone and Fax

Work Phone

Home Phone

Permanent Phone

Fax Number

Application Info

Degree Sought During Proposed Award:

(if applicable)

Expected Graduation Date:

Human Subjects?

YesNo

Human Subjects Assurance Number (If the study involves human subjects)

Research Exempt?

YesNo

Research Exemption Number

NIH-Defined Phase III Clinical Trial?

YesNo

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Sponsoring Institution

Name of Proposed Sponsoring Institution:

Address Line 1

Address Line 2

City

State/Province

Postal Code

Country

Department, Service, Laboratory, or Equivalent:

Major Subdivision:

Entity Tax Identification Number:

Business Official Information

Name of Official in Business Office

First Name

Last Name

Phone

Email

Address Line 1

Address Line 2

City

State/Province

Postal Code

Country

Division/Department Information

Department/Division in which work will be conducted

Department/Division Head Name

First Name

Last Name

Phone

Address Line 1

Address Line 2

City

State/Province

Postal Code

Country

Email

Other Personnel

Other Professional Personnel Associated with the Project (List name, degree and position of each professional associated with the project and indicate their capacity, e.g. Collaborating Investigator, Research Assistant, etc.)

Documentation of Collaborative Arrangements

Upload letter(s) from consultant(s) indicating their willingness to assist in the scientific pursuit of this project and any conditions on such assistance, if applicable. e.g. statistician who will be available to consult with regard to evaluation of data collected.

*All uploaded files must be in either PDF or Microsoft Word format

Click on the "Choose Files" button to find the appropriate file(s) on your computer. Clicking "Open" will upload the file(s). Your file will be automatically uploaded.

How many Consultant Letters do you need to upload?

Consultant Letter 1

Consultant Letter 2

Consultant Letter 3

Consultant Letter 4

Consultant Letter 5

Consultant Letter 6

Consultant Letter 7

Consultant Letter 8

Consultant Letter 9

Consultant Letter 10

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Facilities

Indicate the facilities available for the applicant's use and briefly describe their capacities, relative proximity and extent of availability for applicant's use. Use "other" to describe the facilities at any alternate or secondary research sites or field study sites pertinent to the applicant's research.

Laboratory Space:

Major Equipment (pertinent to project):

Clinical Facilities:

Computer Capabilities:

Office Space:

Other (Provide any other information describing the environment for the project. Identify support services such as consultants, secretaries, etc., that are pertinent to the applicant's research and their availability to the applicant.):

Department Chairman's Letter of Commitment/Verification

Applicants for National Kidney Foundation research grants should attach a letter of commitment from the chairman of their department.

*All uploaded files must be in either PDF or Microsoft Word format

Department Chairperson's Letter

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Applicant Biosketch

Applicant Education

Degree 1

Degree

Field

Month

Year

Institution

Mentor

Degree 2

Degree

Field

Month

Year

Institution

Mentor

Degree 3

Degree

Field

Month

Year

Institution

Mentor

Applicant's Employment/Training

(after college) in chronological order

Activity/Occupation 1

Activity/Occupation

From:

Month

Year

To:

Month

Year

Field

Institution/Company

Supervisor/Employer

Activity/Occupation 2

Activity/Occupation

From:

Month

Year

To:

Month

Year

Field

Institution/Company

Supervisor/Employer

Activity/Occupation 3

Activity/Occupation

From:

Month

Year

To:

Month

Year

Field

Institution/Company

Supervisor/Employer

Prior or Current Research Support

List type (individual and/or institutional), dates, and grant or award numbers for funding that is available to support your research. Explain any budgetary and/or scientific overlap with the proposed NKF funding and the relationship between the project proposed in this application and any other current research awards.

Academic and Professional Honors

Include all scholarships, traineeships, fellowships, and development awards. Indicate source of awards (NSF, Woodrow Wilson, etc.), dates, and grant or award numbers. List current professional societies, if applicable.

Title(s) of Thesis/Dissertation(s)

Name of Dissertation Advisor or Chief of Service

First Name

Last Name

Advisor's Title

Advisor's Department

Advisor's Institution

Applications for Concurrent Support

Is this an application for concurrent support?

YesNo

List all pending support (training, research, supplies, travel, etc.) that would run concurrently with the period covered by this application whether or not you are the Principal Investigator. Include the type, date, source and amount.

Pending Support 1

Type

Source

Date From

Date To

Amount

Pending Support 2

Type

Source

Date From

Date To

Amount

Pending Support 3

Type

Source

Date From

Date To

Amount

Pending Support 4

Type

Source

Date From

Date To

Amount

Pending Support 5

Type

Source

Date From

Date To

Amount

Explain any potential budgetary and/or scientific overlap with the proposed NKF funding and the relationship between the project proposed and any other application for research support:

(Optional) Upload Biosketch

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Research Experience

Summary

Doctoral Dissertation

Publications (published, accepted, submitted, or in preparation)

Time Commitment

Approximate percentage proposed time in activities identified below during period of NKF grant.

Research

%

Teaching

%

Clinical

%

Course Work

%

Total

%

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Lay Summary (A brief (150 words) description of the research that the NKF Patient-Centered Outcomes Research Grant investigator proposes to undertake should be written as a summary for a lay audience. The summary should include a brief discussion of the proposed research and an indication of its potential benefits to the patient with kidney disease. Scientific jargon, abbreviations and complex discussions should be avoided.)

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PART I: Research Proposal

Attach pages describing research proposal in the format described in the respective Instructions to Applicants.
Please observe the page limitations for each section of the research proposal as described in the Instructions to Applicants.

*All uploaded files must be in either PDF or Microsoft Word format

Research Proposal Upload

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References

Please list on this page names and contact information of three persons who are familiar with your scientific interests and abilities.

Then, download the following form, and ask them to use it to submit references.

Reference Form

Have each reference e-mail her/his completed form to: christine.persinger@kidney.org

Reference 1

Full Name

First Name

Middle Name

Last Name

Title

Institution

Department

Phone

Email

Reference 2

Full Name

First Name

Middle Name

Last Name

Title

Institution

Department

Phone

Email

Reference 3

Full Name

First Name

Middle Name

Last Name

Title

Institution

Department

Phone

Email

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Career Development Plans and Statement of Eligibility

(to be completed by the Applicant)

Describe how an NKF research award will help the grantee to take steps towards an independent research career, rather than merely supplement funding from other agencies:

Signatures

Applicant Signature

Note: By signing this application electronically, I certify the information provided is accurate. I understand that an electronic signature has the same effect and can be enforced in the same way as a written signature.

Date

FINALIZE

Finalize Application

Acute Kidney Injury	Cardiology	CKD
Conservation Mgmt	Diabetes	Diabetes Educator
Dialysis	Electrolytes	Electrolytes
Endocrinology	Family Medicine	Gastroenterology
Geriatrics	Glomerulonephritis	Hemodialysis
Home Dialysis	Hypertension	Infectious Disease
Internal Medicine	Living Donation	Mineral Bone
Nephrology	OB/GYN	Other
Patient Care Technician	Pediatric	Peritoneal Dialysis
Polycystic Kidney	Pre-Dialysis Consultation	Pre-ESRD
Primary Care	Radiology	Research