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Call for Applications:

MCW Post-Doctoral Researcher Seed Grants

Eligible MCW Post-Doctoral Researchers are invited to submit the following application, along with their MCW faculty supervisor, to apply for AHW’s Call for Applications: MCW Post-Doctoral Researcher Seed Grants funding opportunity.

The application must be completed and submitted using this online form and no paper or emailed applications will be considered. This application form only supports Plain Text and no text effects such as bold, italics, underlining, bulleting, numbering, etc. will be captured in the form fields in the final submission. No attachments beyond those requested in the call for applications and online form will be accepted.

Please refer to the MCW Post-Doctoral Researcher Seed Grants funding opportunity page on the AHW website for additional instructions and requirements, including the AHW form templates to download, complete and attach in the appropriate fields in the online form.

The deadline for submission is August 19, 2024 by 5:00 p.m. CDT. Late applications will not be accepted.

Please note that all fields marked with * are required.

AHW does not discriminate against individuals on the basis of age, race, creed, religion, color, disability, marital status, sex, national origin, ancestry, sexual orientation, gender identity, arrest record, conviction record, membership in the national guard, state defense force or any other reserve component of the military forces of the United States or the State of Wisconsin or use or nonuse of lawful products off MCW’s premises during nonworking hours.

Project Information

Project Title

Goal Statement - Please provide a brief statement describing the goal of the proposed project, including the intended impact on health and/or health equity in Wisconsin. (maximum 400 characters, including spaces)

Award Budget

Total Amount Requested:

(in whole dollars and

not to exceed $50,000 maximum)

Additional Funds:

(if applicable)

Source of Additional Funds:

(if applicable)

Start Date

Duration of funding:

(in months and

not to exceed 12 months maximum)

Project Team Information

MCW Post-Doctoral Researcher

MCW Post-Doctoral Researcher – The application must be submitted by one (1) eligible MCW Post-Doctoral Researcher for the project. Post-Doctoral Researchers must hold current full-time post-doctoral positions at MCW at the time of application and must remain in their post-doctoral position for the duration of the AHW project period. See the call for applications for eligibility requirements. Collaboration among partners is encouraged, but compliance with fiduciary and reporting requirements are the responsibility of the Post-Doctoral Researcher.

MCW Post-Doctoral Researcher Contact Information


MCW PI Name, MD/PhD:	First	Middle	Last	Suffix/Credentials

Preferred Name:

For example, enter 'John' if that is your preference rather than Johnathan.

Pronouns:

Title:

Work Phone:

Cell Phone:

Email:

MCW Department:

Does your department/center/division have social media handles that you would like to share with AHW?

YesNo

If yes, please provide:

Twitter Handle:	Facebook Handle:
LinkedIn Handle:	Instagram Handle:

What year of your post-doctoral program will you be in at the start of the project, if funded?

MCW Post-Doctoral Researcher Non-Supplanting Attestation

Attach completed Non-Supplanting Attestation (PDF) here:

Co-Investigator(s)

Co-Investigator(s) – Co-Investigator 1 must be the eligible MCW faculty supervisor for the Post-Doctoral Researcher’s work and be committed to supporting the Post-Doctoral Researcher throughout the award period, including guiding research efforts and compliance and management of the award. The MCW Faculty Supervisor must be a full-time or full professional effort MCW faculty member with the rank of Assistant Professor, Associate Professor, or Professor, and have a primary appointment in the School of Medicine.

Additional Co-Is are encouraged, as appropriate, to ensure the necessary skill sets and expertise are engaged in the project. See the call for applications for eligibility requirements. Please note that the online form is limited to five Co-Is total.

MCW Faculty Supervisor/Co-I Contact Information


MCW Co-I Name, MD/PhD:	First	Middle	Last	Suffix/Credentials

Preferred Name:

For example, enter 'John' if that is your preference rather than Johnathan.

Pronouns:

Title:

Work Phone Number:

Email:

Institution:

Department:

MCW Faculty Supervisor/Co-Investigator Non-Supplanting Attestation

Attach completed Non-Supplanting Attestation (PDF) here:

Add additional Co-Investigator(s)?

2. Co-I Contact Information


Co-I Name, MD/PhD:	First	Middle	Last	Suffix/Credentials

Preferred Name:

For example, enter 'John' if that is your preference rather than Johnathan.

Pronouns:

Title:

Work Phone Number:

Email:

Institution:

Department:

Co-Investigator Non-Supplanting Attestation

Attach completed Non-Supplanting Attestation (PDF) here:

Add additional Co-Investigator(s)?

3. Co-I Contact Information


Co-I Name, MD/PhD:	First	Middle	Last	Suffix/Credentials

Preferred Name:

For example, enter 'John' if that is your preference rather than Johnathan.

Pronouns:

Title:

Work Phone Number:

Email:

Institution:

Department:

Co-Investigator Non-Supplanting Attestation

Attach completed Non-Supplanting Attestation (PDF) here:

Add additional Co-Investigator(s)?

4. Co-I Contact Information


Co-I Name, MD/PhD:	First	Middle	Last	Suffix/Credentials

Preferred Name:

For example, enter 'John' if that is your preference rather than Johnathan.

Pronouns:

Title:

Work Phone Number:

Email:

Institution:

Department:

Co-Investigator Non-Supplanting Attestation

Attach completed Non-Supplanting Attestation (PDF) here:

Add additional Co-Investigator(s)?

5. Co-I Contact Information


Co-I Name, MD/PhD:	First	Middle	Last	Suffix/Credentials

Preferred Name:

For example, enter 'John' if that is your preference rather than Johnathan.

Pronouns:

Title:

Work Phone Number:

Email:

Institution:

Department:

Co-Investigator Non-Supplanting Attestation

Attach completed Non-Supplanting Attestation (PDF) here:

Collaborator(s)

Collaborators(s) - Please list additional key members of the project team to demonstrate that the project team brings together individuals with the necessary skill sets, experience, influence, and expertise to carry out the project. Any individual and/or organization listed as a collaborator should be committed to the proposed project and ready to engage in the project based on their specified role, if funded. Collaborators are not subject to MCW faculty eligibility requirements. Please note that the online form is limited to ten collaborators.

Name:	Institution/Organization:	Department:

Do you have any additional project partners labeled as PI/Co-I, or similarly, within the application (including the budget workbook, budget justification, etc.)?

YesNo

If yes, please attach a completed non-supplanting attestation form for each additional individual as a combined PDF here:

Nepotism Attestation

MCW’s Corporate Policies and Procedures for Human Resources – Nepotism (MCW Policy HR.EE.110) states that no MCW employee shall assume, maintain or make Employment or Evaluative Decisions, or conduct Advocacy Activities, with respect to a Relative or Significant Other (“Relationship”) without proper notifications, approvals and development of a management plan as specified in this policy. This policy applies to all MCW employees and students, and all Medical College of Wisconsin Affiliated Hospitals (MCWAH) residents and fellows.

Are there any related individuals involved in the project?

YesNo

If yes, please describe the nature of the relationship and provide a written justification for how the relative’s scientific or technical expertise is required to complete the project’s aims.

AHW Emphasis Areas

Health Equity

Health Equity – AHW is committed to advancing health equity across Wisconsin. Health equity is the state in which everyone has a fair and just opportunity to attain their highest level of health.

Please select all ways that your project aims to impact equity:

Project aims, objectives, strategy or approachProject team participationPopulation the project aims to serve or directly impactHealth issue, disease, or condition the project is focused onOtherThis project is not designed to impact equity

Other, please describe:

Please select one primary category that most closely aligns with the focus of your proposal.

Basic science Clinical science Population science

Narrative

Please see the Call for Applications: MCW Post-Doctoral Researcher Seed Grants for the narrative prompts and instructions.

Attach completed Narrative (PDF) here:

Implementation Plan

Attach completed Implementation Plan (PDF) here:

Budget and Budget Justification

Attach completed Budget Workbook (Excel) here:

Attach completed Budget Justification (PDF) here:

Letters of Support

Attach Letters of Support (combined PDF) here:

Hidden

PI Account ID

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Contact Information

Gender Identity – How do you publicly self-identify? FemaleMaleGender nonbinary/Genderqueer/Gender non-conformingOtherDecline to state	Gender Identity – How do you publicly self-identify? Transgender Not transgender (cisgender)Decline to state
Please describe:

Race – How do you publicly self-identify? Please select all that apply. Asian American/Pacific Islander/AsianBlack/African American/AfricanLatino/Latina/LatinxNative American/American Indian/IndigenousWhite/Caucasian/EuropeanMulti-racial/Multi-ethnic (two or more races or ethnicities)Different identityDecline to state	Ethnicity – How do you publicly self-identify? Hispanic or Latino/Latina/LatinxNot Hispanic or Latino/Latina/LatinxDecline to state
Please specify:

Sexual Orientation – How do you publicly self-identify? Heterosexual or straightGay, lesbian, bisexual (or other sexual orientations within the LGBTQIA+ community) Different identityDecline to state	Disability Status – How to you publicly self-identify? I identify as a person with disabilityI do not identify as a person with a disabilityDecline to state
Please specify:

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