Initial Grant Application

Through The Gateway’s pre-application process, initial study ideas are reviewed for alignment with The Gateway’s stated mission and purpose. By eliminating study ideas inconsistent with our mission and purpose researchers save the time it takes to prepare full applications. Upon review of information provided below, you will be notified of next steps including submission of our Full Application for Funding. All documentation provided is evaluated by scientific experts serving on our Board of Scientific Counselors. Eveline Mumenthaler is The Gateway's Director of Research and Grants. Please contact Eveline with any questions and prior to beginning your online application.

Learn more about what we fund.

Once your form is submitted you will receive an email confirmation that your application is under review by The Gateway’s research team.

Please Note: Review the application in its entirety before beginning to ensure you have all necessary materials to complete it in one session. Once you start the form you will not be able to save it or return to an incomplete application. Questions? Please contact The Gateway's Director of Research & Grants.

Primary Investigator First Name: *

Primary Investigator Last Name: *

Email: *

Secondary Email:

Office Phone Number: *

Mobile Phone Number:

Other Phone Number:

Address: *

Address #2:

Address #3:

City: *

State:

Country: *

Zip Code: *

Affiliated Institution(s) and/or Companies: *

Primary Research Institution: *

Involved Departments and/or Research Institutions: *

Title(s) (with respect to each department): *

Date of Hire:

Title of Proposed Human Cancer Treatment Clinical Trial:

Have you ever applied for a grant with The Gateway for Cancer Research in the past?: *

Yes

If Yes, what was the date and title of the proposed Study?:

Primary Area of Research: *

What difference is your proposed treatment going to make in the life of cancer patients right now?: *

How many patients will you treat in this trial (and what are the cohorts)? : *

What is the total cost, standards of care cost, and additional study cost?: *

Provide the appropriate approval for your protocol (IRB):

Click "Browse" to select a file to upload. The maximum file size per upload is 5 MB.

Provide the appropriate approval for your protocol (IND):

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If the approvals have not yet been recieved, what is your timeline for receiving the approvals? : *

How many patients will you enroll in this trial each month upon receipt of The Gateway funding? : *

What do you expect your treatment to do for these patients? (Therapeutic vs. Research intent): *

Why do you expect your treatment to work for the patients in the study?: *

What are the steps a patient goes through once enrolled in this study? (Attach a timeline for the whole protocol indicating standard of care or clinical):

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What will be done for patients with positive results who are near completion or have finished their treatment plans but are not cured?: *

If your proposed treatment requires use of pharmaceutical and/or biotechnology compounds (including monoclonal antibodies) have you secured the manufacturer’s underwriting for the supply of these compound(s)?: *

Yes

N/A

If not, why?:

How many years do you expect this trial to take in its entirety?: *

Why?: *

After receiving The Gateway funding when will you provide us reports on results you are seeing with this trial?: *

How many patients have you treated in all your past clinical trials combined -PERSONALLY?: *

How many patients have you treated in all your past clinical trials combined -AS A DEPARTMENT?: *

How many patients are you currently treating in general now- PERSONALLY?: *

How many patients are you currently treating in general now- AS A DEPARTMENT?: *

What does your typical weekly work schedule look like day-by-day?: *

How many of your current patients are participating in a clinical trial in which you are currently collaborating and/or another in which you encouraged them to participate? ( please denote each separately) : *

How EXACTLY is the Gateway money you receive going to be spent? (Attach your VERY DETAILED budget and expenses sheet): *

Attach Budget -PDF file or Office 2003:

Click "Browse" to select a file to upload. The maximum file size per upload is 5 MB.

Are you willing to immediately share portions of your grant award with other clinicians who have patients meeting screening criteria and wanting to participate in this trial?: *

What are the next steps if your treatment results successfully meet this trial’s objectives?: *

At which point(s) will you voluntarily shut down this trial and/or propose changes for higher patient impact?: *

What is your personal motivation for conducting this trial?: *

Why did you choose the institution(s)/company where you work?: *

What is your brief analysis of the 20-year scope of research and progress regarding and related to this proposed clinical treatment trial?: *

How many professionals outside of your current institution(s)/company have you consulted regarding viability and /or orginally of this proposed clincial treatment trial: *

Please describe any machinery to be used in this trial (brand, model, year of make, etc.).: *

I would like to receive email updates from The Gateway for Cancer Research.

I would like to allow The Gateway for Cancer Research to show my response on this website.

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