ACDS Diversity, Equity, Inclusion, and Healthcare Disparities Award

Thank you for your interest in applying for the ACDS Diversity, Equity, Inclusion, and Healthcare Disparities Award Grant. Please complete the below information and submit by the designated deadline to be considered for the grant. Please contact info@contactderm.org or call 414-918-9805 with any questions you might have.

* = required field

Applicant's Contact Information

First Name*:

Last Name*:

Company/Institution*:

Applicant's Title (MD, PhD, etc)*:

Professional Level: (Medical Student, Resident, Fellow, etc.) *:

Street/Mailing Address*:

City*:

State/Province*:

ZIP/Postal Code*:

Country*:

Email*:

Sponsor Information

Sponsor Name*:

Sponsor Email*:

Sponsor Institution*:

Proposal

Title of Proposal*:

Area of Focus in Contact Dermatitis*:

Proposed Dates of program*:

Research Location*:

Amount Requested*:

Outline of Proposal

Please do not exceed five pages, including budget, and upload as a PDF document.

Specific aims: Explain your hypothesis and what you plan to accomplish.
Significance: Why is this work important?
Preliminary studies/background: Present prior work you have accomplished. Review relevant literature.
Methods: Explain your experimental design and plan for data analysis. Explain how protected health information will be stored, shared, and destroyed.
References: Citations from literature.
Budget: Provide a one-page detailed budget including expenses for database management; statistical analysis; presentation expenses. Funding is not designed to be used for indirect institutional costs, including salary for investigator or supervisor, travel to meetings, or overhead costs, at universities. Personnel costs for data analysis, are acceptable. Travel may be approved under special circumstances.

Research Proposal (PDF)*:

Budget (PDF)*:

Curriculum Vitae/Biosketch (PDF)*:

Letter(s) of support (PDF)*:

IRB Approval Status (PDF)*:

I certify that the statements in this application are true to the best of my knowledge. I agree that the award funds will be used only for the purpose reflected in my application. Any unused funds will be returned to the ACDS. I hereby agree to provide a written progress report and financial report to the ACDS within 90 days of the termination of my research program.