The Brain Aneurysm Foundation

The Society for Neuroscience in Anesthesiology and Critical Care (SNACC)

William L. Young Neuroscience Award Application

2016 The Society for Neuroscience in Anesthesiology and Critical Care (SNACC) William L. Young Neuroscience Award 2016

The eligibility requirements are: 1) SNACC member (US or International) 2) No more than 10 years from completion of Medical Degree or DO 3) Applicant may hold faculty rank no greater than Assistant Professor. The inaugural William L. Young Neuroscience Research Award will be announced at the 2016 SNACC Annual Meeting in Chicago, Illinois. The successful applicant will receive $5,000.00 to support their research.

Deadline: Friday, July 15, 2016 Please send to Sandra Peterson when completed. Email: [email protected] 804-565-6360. Thank you!

PROJECT TITLE:

Project Type: Basic Science:______Translational:______Clinical/Outcome: ______

APPLICANT INFORMATION

Name: Birth date: Gender:

Business Street Address:

City: State: Zip:

Telephone: Fax: E-mail:

Current status (choose one)  Fellow  Instructor  Assistant Professor

Citizenship Status (choose one)  US Citizen  Non-US Citizen

Are human experiments involved in this project?

Are copies of the institutional review board approval attached to the application?

If no, give date of anticipated approval at which time copies will be forwarded:

Are animal experiments involved in this project?

Are copies of the institution’s animal care and use committee approval attached to the application?

Name: APPLICANT INSTITUTION

Street Address:

City: State: Zip:

Telephone: Fax:

SIGNATURES By signing below, I hereby attest that information contained in this application is accurate and true.

Signature of applicant______Date______

Signature of financial officer______Date______(of the applicant institution)

ABSTRACT OF PROPOSED RESEARCH Briefly describe the research project technical approach and anticipated results. Describe how this project will potentially advance the field of neuroscience for anesthesiology and critical care research Abstract should not exceed half-page, 11 size font and single spaced limit.

______Specific Aims, Research Method and Preliminary results. You may use a separate page if necessary. Description should not exceed 3 pages, 11 size font single spaced limit. Appendices should not exceed 5 pages.

BIOGRAPHICAL SKETCH Provide the following information for the key personnel and other significant contributors Follow this format for each person. DO NOT EXCEED FOUR PAGES. NAME POSITION TITLE

EDUCATION/TRAINING (Begin with baccalaureate or other initial professional education, such as nursing, and include postdoctoral training.) DEGREE INSTITUTION AND LOCATION YEAR(s) FIELD OF STUDY (if applicable)

A. Positions and Honors. List in chronological order previous positions, concluding with your present position. List any honors.

B. Selected peer-reviewed publications (in chronological order). Do not include publications submitted or in preparation. For publicly available citations, URLs or PMC submission identification numbers may accompany the full reference.

C. Research Support. List selected ongoing or completed (during the last three years) research projects. Begin with the projects that are most relevant to the research proposed in this application. Briefly indicate the overall goals of the projects and your role (e.g. PI, Co-Investigator, and Consultant) in the research project.