Award for Young Investigators in Dermatology - Application Form

Eligible candidates include US and Canadian dermatology residents and fellows, as well as dermatologists who have completed their research by age 35 or within 7 years of completing a terminal degree.

Due: October 15, 2014

Applicant Information

First Name
Last Name
Title / Degree
Institution Name
Institution Country
Institution Address 1
Institution Address 2
Institution City
Institution State/Province
Institution Postal Code
Phone
Fax
Email

Research Information

Title of Research Project
Type
Description
Explain briefly the reason for the investigations and how the project was developed: (100 words or less)
Objectives and purpose of the Research (100 words or less)
Methods used (100 words or less)
Results derived (200 words or less)
Conclusions reached (200 words or less)
Describe briefly how the research project has benefited the specialty of dermatology (100 words or less)

Collaborators & Funding

Please note: If external collaborators or sources of external funding represent any perceived  or actual conflict of interest with AAD and its mission, the AAD reserves the right to exclude the applicant from consideration.
Please list any collaborators in this project
Was the research funded by any external sources
If yes, name the funding source  

Attached Documentation

Supplemental materials should relate directly to the questions in this form.
Narrative Description A two page, double-spaced narrative description of the applicant's research, including appropriate reference list.
Letter of Recommendation One letter of recommendation from either the department chair or the faculty advisor.
Brochure A brochure or brief, one-page description of the residency program or dermatology department supporting the research efforts.
Curriculum Vitae Applicant's abbreviated CV (not to exceed four pages)
Other Optional documentation
Other Optional documentation