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  • 1. American Heart Association, Founders Affiliate Martin B. Leon/Johnson & Johnson Cordis Corporation Interventional Cardiology Award PROJECT SUMMARY 1. Applicant :                            First Middle Last Jr/Sr/etc Degree(s) 2. Institution where work will be done:       3.Sponsor(if applicable) :                            First Middle Last Jr/Sr/etc. Degree(s) 4.Department Head: :                      First Middle Last Jr/Sr/etc. 5. Applying to: Founders Affiliate 6. Award program: Leon/Johnson & Johnson Cordis Corp. Interventional Cardiology Award 7. Resubmission? Yes No Previous Application ID #:       8. Dates of proposed award: Start:       End:       mm/dd/yyyy mm/dd/yyyy 9. Project title (limit to 50 characters or less):       10. Project summary (must be completed on this page):       11. Amount Requested:                              
  • 2. Year 1 Year 2 Year 3 Year 4 Year 5
  • 3. PROJECT PERSONNEL/SIGNATURES 1. Other professional personal associated with the project: (List name, degree and position of each professional associated with the project, with indication of capacity, e.g., Consultant, Collaborating Investigator, Other Professional, Technician, etc. See instructions for definitions of roles.) % of Name & Degree Institution Position Title Role in Project Time First:                         Last:       Degree:       First:                         Last:       Degree:       First:                        Last:       Degree:       First:                         Last:       Degree:       First:                         Last:       Degree:       First:                         Last:       Degree:       First:                         Last:       Degree:       2. Signatures The undersigned have reviewed this application for an American Heart Association clinically applied research award and are familiar with the conditions, policies and objectives of the AHA concerning research support and accept the obligation to comply with all such conditions, policies and objectives of the supporting Heart Association. Applicant (Please Type) Signature Date             Sponsor (If Applicable) Signature Date             Department Head (Please Type)             Institution which assumes fiscal responsibility             Official signing for applicant institution Signature Date                   Applicant’s Name (Please Type)
  • 4. APPLICANT INFORMATION Current Address 1. Applicant:                       First Middle Last Degree(s) 2. E-mail address:       3. Department:       4. Division:       5. Institution:       6. Address:       7. Address:       8. City:       9. State:    Zip code:       Country:       10. Phone Number:       Fax:       Institution where work will be done Place an X here and do not complete if same as current address 11. Department:       12. Division:       13. Institution:      14. Address:       15. Address:       16. City:       17. State:    Zip code:       Country:       18. Phone Number:       Fax:       Effective Date:       19. Applicant’s present title:       20. Applicant’s present academic position: 21. Applicant’s title at award activation:       22. Applicant’s academic position at award activation: Intern 23. Career stage:
  • 5. APPLICANT INFORMATION (continued) 24. First full-time faculty/staff appointment:       mm/yyyy 25. First full-time faculty/staff appointment at assistant professor (or equivalent) level:       mm/yyyy 26.1st doctoral degree:       Date earned:       mm/yyyy 27. Specialty ( 1st degree):             mm/yyyy 28. 2nd doctoral degree:       Date earned:       mm/yyyy 29. Specialty (2nd degree):       30. If you have not received a doctoral degree, please indicate: Date (mm/yyyy) Date of actual or expected completion of required course work:       Date of actual or expected admission to doctoral degree candidacy:       31. For Postdoctoral Fellowship applicants only, indicate length of postdoctoral research training or experience (exclusive of clinical training) as of award activation date:       yrs       mos 32. Indicate total annual grant support available to the applicant, exclusive of salary /fringe and indirect costs:       33. Please indicate any of the following awards you have received or currently hold: ACS Clinical Research Training Grant for Junior Faculty Leukemia & Lymphoma Society Special Fellow ACS Research Scholar Grant for Beginning Investigator NIH Career Transition Award (K22) AHA Scientist Development Grant NIH Independent Scientist Award (K02) Alzheimer’s Assoc. New Investigator Research Grant NIH Sponsored Clinical Scientist Dev Award (K08) American Lung Assoc. Career Investigator NIH Research Project Grant (R01) Arthritis Foundation Investigator Award NIH Senior Scientist Award (K05) Arthritis Foundation Physician Scientist Dev Award Pfizer Scholar Grant for New Faculty Burroughs Wellcome Fund Award United Cerebral Palsy Hausman Clinical Scholar Award Howard Hughes Award Veterans Administration Award Leukemia & Lymphoma Society Scholar Whitaker Foundation Biomedical Engineering Research
  • 6. Grant Other Specify                   ACS - American Cancer Society AHA – American Heart Assoc. NIH – National Institutes of Health 34.Country of citizenship:       35. Immigration (Status/Visa):
  • 7. ADMINISTRATIVE INFORMATION Sponsor Name/Address (complete Sponsor information only if your program requires a Sponsor) 1. Sponsor:                             First Middle Last Jr/Sr/etc Degree(s) 2. Department:       3. Division:       4. Institution:      5. Address:       6. Address:       7. City:       8. State:    Zip code:       Country:       9. Phone Number:       Fax:       10. E-mail address:       Grants Officer Name/Address (Pre-Award) 11. Grants Officer:                       First Middle Last Jr/Sr/etc 12. Department:       13. Institution:      14. Address:       15. Address:       16. City:       17. State:    Zip code:       Country:       18. Phone Number:       Fax:       19. E-mail address:       Fiscal Officer Name/Address (Post-Award) 20. Fiscal Officer:                       First Middle Last Jr/Sr/etc 21. Department:       22. Institution:      23. Phone Number:       Fax:       24. E-mail address:            
  • 8. Applicant’s Name (Please type)
  • 9. ADMINISTRATIVE INFORMATION (continued) Percent Time 25. Percent of applicant’s total effort devoted to this project:       26. Indicate percent of time applicant spends on: A. Administration      % E. Coursework      % B. Patient care      % F. Other      % C. Research      % D. Teaching      % G. Total 0% Project Endorsements 27.Research involves: Yes No a) Recombinant DNA? b) Biohazards (other than recombinant DNA)? c) Human subjects? d) Adult human stem cells? e) Human embryonic or fetal stem cells? f) Human fetal tissue? g) Cloning? Date       h) Animal subjects? Approved i) If using animals, is your       Effective institution accredited by date: AAALAC? j) If using animals, does your       institution have a current PHS ID number: Animal Welfare Assurance? a) b) and g) -No documentation required c) and d) -IRB documentation required prior to award activation. e) and f) -If yes, you are not eligible to apply to the American Heart Association. h) -IACUC documentation required prior to award activation. (See Application Instructions for details.)
  • 10.       Applicant’s Name (please type)
  • 11. BIOGRAPHICAL SKETCH (PI) Do not exceed 5 pages for the complete Biographical Sketch, including bibliography Name:                             First Middle Last Jr/Sr/etc Degree(s) Position/Title:       Education/Training: (Begin with entry into college and include postdoctoral training.) Institution and Location Dates Degree Conferred Field of Study Attended (if applicable) (mm/yyyy)                                                                                                                                                                                                                                                                                                             For Principal Investigator Only: Address personal variances from ordinary career progression, including part-time work, if applicable. Positions, Publications and Research Support (create these pages as PDFs) 1) Positions/Employment, Memberships and Honors – List in chronological order previous positions, concluding with your present position. Include star/end dates, position title, name of organization and department. Also list other experience and professional memberships, and academic/professional honors received. If necessary senior applicants may list previous employment for the past 15 years and should be very selective regarding memberships/honors. 2) Peer-reviewed Publications – List, in chronological order, selected peer-reviewed publications. Do not include publications submitted or in preparation. 3) Research Support – List selected ongoing or completed (during the last three years) research projects. Give project number, agency, title of project, and dates of award. Then briefly indicate the overall goals of the projects and your role (e.g., PL, Co-Investigator, Consultant) in the research project. Do not list award amounts or percent effort in projects.
  • 12.       Applicant’s Name (please type)
  • 13. CO-AUTHORS/REFERENCES Co-Authors: Please list each co-author (at assistant professor level or above) with whom you have published an article or abstract within the past 3 years. Last name First initial Last name First initial Last name First initial                 Johnson (SAMPLE) M                                                                                                                                                                                                                                                                                                                                                                                                                         Current Supervisor:                       First Middle Last Degree(s) References (if applicable): List names and addresses of persons familiar with your scientific interests and abilities and who have been requested to submit a Reference Report for Applicant. (See application instructions for number of Reference Reports needed and further requirements.) Name (last name, first name) Title Department Institution First:                         Last:       First:                         Last:       First:                         Last:            
  • 14. Applicant’s Name (please type)
  • 15. RESEARCH PROJECT ENVIRONMENT FACILITIES: specify the facilities to be used for the conduct of the proposed research. Indicate the performance sites and describe capacities, pertinent capabilities, relative proximity, and extent of availability to the project. Under “Other, “ identify support services and specify the extent to which they will be available to the project. Use continuation pages if necessary. Location(s):       Computer Support:       Office:       Other:       MAJOR EQUIPMENT: List the most important items already available for this project, noting the location and pertinent capabilities of each.            
  • 16. Applicant’s Name (please type)
  • 17. PROJECT BUDGET Proposed Project Budget Year 1 Year 2 $ Amount $ Amount 1. Salary & Fringe Benefits (Salary)             of Investigators/team (Fringe)             2. Project Costs             (if allowed for program) 3. Subtotal (lines 1 & 2) $0.00 $0.00 4. Indirect Costs             (if allowed by AHA funding component) 5. Total Costs $0.00 $0.00       Applicant’s Name (please type)
  • 18. OTHER SUPPORT There is no form page for other support. Information on other support should be provided in the format shown below, using blank pages. Include the Principal Investigator’s name at the bottom (right-hand side) and number consecutively with the rest of the application. The sample is intended to provide guidance regarding the type and extent of information requested, If you have no active or pending support, complete an Other Support page with the PI’s name and state “None” Format NAME OF INDIVIDUAL ACTIVE/PENDING Project number (Principal Investigator) Dates of Approved/Proposed Project Source Annual Direct Costs Percent Effort Title of Project (or Subproject) The major goals of this project are… OVERLAP/ALTERNATIVE (scientific and/or budgetary, summarized for each individual) ANDERSON, R.R. ACTIVE 2 RO1 HL 00000-13 (Anderson) 3/1/99-2/28/02 30% NIH/NHLBI $186,529 Chloride and Sodium Transport in Airway Epithelial Cells The major goals of this project are to define the biochemistry of chloride and sodium Transport in airway epithelial cells and clone the gene(s) involved in transport. 5ROI HL 00000-07 (Baker) 4/1/97-3/31/02 10% NIH/NHLBI $122,717 lon Transport in Fetal Lung The major goal of this project is to study chloride and sodium transport in normal and cystic fibrosis fetal lung. PENDING 5 RO1 HL 00000-22 (Anderson) 12/01/99-11/30/01 20% NIH/NHLBI $82,163 Liposome Membrane Composition and Function The major goals of this project are to define biochemical properties of liposome membrane components and maximize liposome uptake into cells.
  • 19. ALTERNATIVE There is scientific overlap between aim 2 of NIH HL 00000-22 and aims 3 and 4 of the application under consideration. This application is alternative to the AHA proposal.
  • 20. FUNDS AVAILABLE (1) - APPLICANT List active or approved awards first, and then list all pending awards. 1. Funding agency:       2. Award name/ID number:       3. Project title:       4. Principal Investigator:       5. Applicant’s role:       6. Beginning date of award:       7. Ending date of award:       8. Award status: Active Approved Pending 9. Total award:       10. Total amt available to applicant:       11. Annual amt available to applicant*:      * Do not include applicant’s salary/fringes or intramural support dollars 12a. Is this project overlapping* (current award) or alternative* (pending award) to this AHA proposed project? *scientific or budgetary Yes No 12b. Whether you answer yes or no, please describe relationship to this AHA project. (See Application Instructions, Funds Available section, for AHA’s definitions and policies regarding Alternative and Overlapping applications. Note: 100% duplication between applications is not a requirement for an application to be deemed alternative or overlapping. The Research Committee may deem an application as alternative or overlapping if there is any duplication of scientific aims or budget.)       (Remember to submit summary/abstract, specific project aims, budget, and budget justification pages for this project with paper sets. See Application Instructions, Enclosures from Applicant section for details.) 1. Funding agency:       2. Award name/ID number:       3. Project title:       4. Principal Investigator:       5. Applicant’s role:       6. Beginning date of award:       7. Ending date of award:       8. Award status: Active Approved Pending 9. Total award:       10. Total amt available to applicant:       11. Annual amt available to applicant*:      * Do not include applicant’s salary/fringes or intramural support dollars 12a. Is this project overlapping* (current award) or alternative* (pending award) to this AHA proposed project? *scientific or budgetary Yes No 12b. Whether you answer yes or no, please describe relationship to this AHA project. (See Application Instructions, Funds Available section, for AHA’s definitions and policies regarding Alternative and Overlapping applications. Note: 100% duplication between applications is not a requirement for an application to be deemed alternative or overlapping. The Research Committee may deem an application as alternative or overlapping if there is any duplication of scientific aims or budget.)       (Remember to submit summary/abstract, specific project aims, budget, and budget justification pages for this project with paper sets. See Application Instructions, Enclosures from Applicant section for details.) Applicant’s Name:      
  • 21. FUNDS AVAILABLE (2) - APPLICANT List active or approved awards first, and then list all pending awards. 1. Funding agency:       2. Award name/ID number:       3. Project title:       4. Principal Investigator:       5. Applicant’s role:       6. Beginning date of award:       7. Ending date of award:       8. Award status: Active Approved Pending 9. Total award:       10. Total amt available to applicant:       11. Annual amt available to applicant*:      * Do not include applicant’s salary/fringes or intramural support dollars 12a. Is this project overlapping* (current award) or alternative* (pending award) to this AHA proposed project? *scientific or budgetary Yes No 12b. Whether you answer yes or no, please describe relationship to this AHA project. (See Application Instructions, Funds Available section, for AHA’s definitions and policies regarding Alternative and Overlapping applications. Note: 100% duplication between applications is not a requirement for an application to be deemed alternative or overlapping. The Research Committee may deem an application as alternative or overlapping if there is any duplication of scientific aims or budget.)       (Remember to submit summary/abstract, specific project aims, budget, and budget justification pages for this project with paper sets. See Application Instructions, Enclosures from Applicant section for details.) 1. Funding agency:       2. Award name/ID number:       3. Project title:       4. Principal Investigator:       5. Applicant’s role:       6. Beginning date of award:       7. Ending date of award:       8. Award status: Active Approved Pending 9. Total award:       10. Total amt available to applicant:       11. Annual amt available to applicant*:      * Do not include applicant’s salary/fringes or intramural support dollars 12a. Is this project overlapping* (current award) or alternative* (pending award) to this AHA proposed project? *scientific or budgetary Yes No 12b. Whether you answer yes or no, please describe relationship to this AHA project. (See Application Instructions, Funds Available section, for AHA’s definitions and policies regarding Alternative and Overlapping applications. Note: 100% duplication between applications is not a requirement for an application to be deemed alternative or overlapping. The Research Committee may deem an application as alternative or overlapping if there is any duplication of scientific aims or budget.)       (Remember to submit summary/abstract, specific project aims, budget, and budget justification pages for this project with paper sets. See Application Instructions, Enclosures from Applicant section for details.) Applicant’s Name:      
  • 22. FUNDS AVAILABLE (3) - APPLICANT List active or approved awards first, and then list all pending awards. 1. Funding agency:       2. Award name/ID number:       3. Project title:       4. Principal Investigator:       5. Applicant’s role:       6. Beginning date of award:       7. Ending date of award:       8. Award status: Active Approved Pending 9. Total award:       10. Total amt available to applicant:       11. Annual amt available to applicant*:      * Do not include applicant’s salary/fringes or intramural support dollars 12a. Is this project overlapping* (current award) or alternative* (pending award) to this AHA proposed project? *scientific or budgetary Yes No 12b. Whether you answer yes or no, please describe relationship to this AHA project. (See Application Instructions, Funds Available section, for AHA’s definitions and policies regarding Alternative and Overlapping applications. Note: 100% duplication between applications is not a requirement for an application to be deemed alternative or overlapping. The Research Committee may deem an application as alternative or overlapping if there is any duplication of scientific aims or budget.)       (Remember to submit summary/abstract, specific project aims, budget, and budget justification pages for this project with paper sets. See Application Instructions, Enclosures from Applicant section for details.) 1. Funding agency:       2. Award name/ID number:       3. Project title:       4. Principal Investigator:       5. Applicant’s role:       6. Beginning date of award:       7. Ending date of award:       8. Award status: Active Approved Pending 9. Total award:       10. Total amt available to applicant:       11. Annual amt available to applicant*:      * Do not include applicant’s salary/fringes or intramural support dollars 12a. Is this project overlapping* (current award) or alternative* (pending award) to this AHA proposed project? *scientific or budgetary Yes No 12b. Whether you answer yes or no, please describe relationship to this AHA project. (See Application Instructions, Funds Available section, for AHA’s definitions and policies regarding Alternative and Overlapping applications. Note: 100% duplication between applications is not a requirement for an application to be deemed alternative or overlapping. The Research Committee may deem an application as alternative or overlapping if there is any duplication of scientific aims or budget.)       (Remember to submit summary/abstract, specific project aims, budget, and budget justification pages for this project with paper sets. See Application Instructions, Enclosures from Applicant section for details.) Applicant’s Name:      
  • 23. FUNDS AVAILABLE (4) - APPLICANT List active or approved awards first, and then list all pending awards. 1. Funding agency:       2. Award name/ID number:       3. Project title:       4. Principal Investigator:       5. Applicant’s role:       6. Beginning date of award:       7. Ending date of award:       8. Award status: Active Approved Pending 9. Total award:       10. Total amt available to applicant:       11. Annual amt available to applicant*:      * Do not include applicant’s salary/fringes or intramural support dollars 12a. Is this project overlapping* (current award) or alternative* (pending award) to this AHA proposed project? *scientific or budgetary Yes No 12b. Whether you answer yes or no, please describe relationship to this AHA project. (See Application Instructions, Funds Available section, for AHA’s definitions and policies regarding Alternative and Overlapping applications. Note: 100% duplication between applications is not a requirement for an application to be deemed alternative or overlapping. The Research Committee may deem an application as alternative or overlapping if there is any duplication of scientific aims or budget.)       (Remember to submit summary/abstract, specific project aims, budget, and budget justification pages for this project with paper sets. See Application Instructions, Enclosures from Applicant section for details.) 1. Funding agency:       2. Award name/ID number:       3. Project title:       4. Principal Investigator:       5. Applicant’s role:       6. Beginning date of award:       7. Ending date of award:       8. Award status: Active Approved Pending 9. Total award:       10. Total amt available to applicant:       11. Annual amt available to applicant*:      * Do not include applicant’s salary/fringes or intramural support dollars 12a. Is this project overlapping* (current award) or alternative* (pending award) to this AHA proposed project? *scientific or budgetary Yes No 12b. Whether you answer yes or no, please describe relationship to this AHA project. (See Application Instructions, Funds Available section, for AHA’s definitions and policies regarding Alternative and Overlapping applications. Note: 100% duplication between applications is not a requirement for an application to be deemed alternative or overlapping. The Research Committee may deem an application as alternative or overlapping if there is any duplication of scientific aims or budget.)       (Remember to submit summary/abstract, specific project aims, budget, and budget justification pages for this project with paper sets. See Application Instructions, Enclosures from Applicant section for details.) Applicant’s Name:      
  • 24. RESEARCH CLASSIFICATION (1) The American Heart Association is frequently asked to categorize the research it is funding by a number of different categories. These requests can originate with our donors, the general public or our many volunteers. Please complete each of the following classifications as they relate to your research. The classifications are independent of each other and the classification of your research will not affect the peer review of your application. CVD/Stroke Classification (select only one) CVD - related CVD and closely stroke-related CVD and broadly stroke-related Closely stroke-related (see list below) Broadly stroke-related (see list below) Current Areas of Interest (If applicable to your project, select one or both. Otherwise leave blank) To improve population and/or behavioral methods or develop novel methods to advance primary and/or secondary prevention goals of the American Heart Association To improve the effectiveness of therapy, quality of care and systems of healthcare delivery goals of the American Heart Association. As a general rule, AHA considers closely related to stroke to include projects involving brain blood vessels, brain tissue, or cerebral ischemia. Projects broadly related to stroke include those involving vascular biology in other vascular beds and coagulation control systems. The following list of stroke terms may assist you: Closely Related to Stroke Broadly Related to Stroke Cerebellum Cerebral infarction Blood pressure control Cerebrovascular disorders Cerebral ischemia Blood vessel growth & development Carotid artery diseases Cerebral ischemia, transient Hypertension Carotid artery atherosclerosis Subclavian steal syndrome Hypoxia Carotid artery thrombosis Leukomalacia, periventricular Ion channels and blockers Carotid stenos is Vascular headache Intracellular motility Moyamoya disease Cluster headache Micro-circulation Cerebral amyloid angiopathy Migraine Platelets & platelet activation Cerebral aneurysm Vertebrobasilar insufficiency Smooth muscle Cerebral anoxia Dura Thrombosis Cerebral arteriosclerosis Echoencephalography Transmitter Cerebral arteriovenous malformations Hypothalamus Control Cerebral artery diseases Mid-Brain Release Cerebral circulation Neuroglia Synthesis Cerebral embolism and thrombosis Neurons Vascular biology Carotid artery thrombosis Pia Mater; Pia Vein Vascular endothelium Sinus thrombosis Ventricle Vascular injury Wallenberg's syndrome Vascular intema Cerebral hemorrhage Vascular reactivities Hematoma, epidural Vascular tone Hematoma, subdural Subarachnoid hemorrhage       Applicant’s Name (please type)
  • 25. RESEARCH CLASSIFICATION (2) Types of Research (select only one) Basic Biomedical Research is conducted to increase understanding of fundamental life processes. Clinical Research addresses important questions of normal function and disease using human subjects. Population Health Research is the science and art of studying the distribution and determinants of health status as influenced by social, economic, and physical environments, human biology, health policy and services and of preventing disease, prolonging life and promoting health at the population level. Research Categories (select all that apply) African Americans Imaging Aging/elderly Medications Angiogenesis Native Americans Angioplasty Nutrition Asian Americans Obesity Behavioral research Outcomes research Cholesterol Pediatric research Diabetes Physical activity/inactivity Emergency cardiac care/defibrillation/ Rehabilitation chain of survival Epidemiological research Smoking/tobacco Gene therapy Stroke Heart attack Surgical techniques Heart failure Transplantation Heart valves Treatment/patient care High blood pressure Women Hispanic/Latino American       Applicant’s Name (please type)
  • 26. SCIENCE CLASSIFICATION (1) Assignment to a peer review group is based largely upon the Major Science Categories that you choose below (not the sub-categories). 1.Choose two Major Science Categories from those listed below. 2.For each Major Science Category, choose up to six (6) sub -category terms most relevant to your proposal. NOTE: If you have checked Resubmission on page 1 of your application and the Major Science Classification choices you make are different from your previous submission, your application might not be reviewed by the same scientific peer review committee. With any choice, prior critiques and scores are provided to the new reviewers. If you make an error or wish to start again, click on the "Reset" button(s) to clear the fields within each group. Major Science Classification (1) Sub Classification(s) Major Science Classification (2) Sub Classification(s) 1205 - BEHAVIORAL SCIENCE, EPIDEMIOLOGY & PREVENTION 2060 - BASIC CELL & MOLECULAR BIOLOGY 1090 Biomedical Ethics 2078 Cell Adhesion/Extracellular Matrix 1115 Cardiac Rehabilitation 3001 Cell Proliferation/Cell Cycle 1405 Cost Effectiveness 1217 Chromatin, Nuclear Matrix & Mitosis 1340 Epidemiology of CVD 1294 Cytoskeletal Signaling 1355 Exercise/Physical Activity 1057 Cytoskeleton & Motility 1375 Genetic Epidemiology 1506 Intracellular Targeting 1400 Health Promotion/Prevention 2161 Intracellular Trafficking 1445 Nutrition 1815 Muscle Cell Contractility 2163 Prevention & Management of Diabetes & 1720 Physical Biochemistry Multiple Metabolic Syndrome 2162 Post Translational Protein Modifications 3004 Prevention & management of Hypertension 1761Protein Structure-function Relationships 1762Protein/DNA Interactions 1763Protein/Protein Interactions Including 1205 - BEHAVIORAL SCIENCE, EPIDEMIOLOGY & PREVENTION Contractile Proteins 3002 Proteomics 2164Prevention & Management of Obesity 1820 Regulation of Gene Expression 1760 Preventive Cardiology 3003 Stem Cell Biology 2165Psycho/Social Factors 2064 Structural Biology 1795 Quality of Life 1814 Structural Studies of Contractile & Other Proteins 2050 - BIOENGINEERING & BIOTECHNOLOGY
  • 27. 2054 Bioelectrics 2056Bioinformatics 2057Biomaterials 2058Biomechanics 2166 Biotransport Processes 2065Chemistry & Chemical Synthesis 2066Computation, Modeling & Simulation 2167 Computational Systems Biology 2067 Defibrillators & Pacemakers 2168 Pacing & Devices 2059 Drug Delivery 2169 Electrophysiology Modeling 2060 Image Methods, Analysis & Processing 2170 Mechanical Cardiac Assistance & Replacement Technology 2062 Molecular/Cellular Tissue Engineering & Technologies 2068Nanotechnology 2069Non-linear Dynamics (Chaos & Fractals) 3026 Rehabilitation Engineering 2063 Sensors and Devices 2070 Signal Processing & Analysis
  • 28. SCIENCE CLASSIFICATION (2) 1100- BRAIN 3100 - CARDIAC ELECTROPHYSIOLOGY & ARRHYTHMIAS/REGULATION 3005 Astrocytes 2173Ablation 1095 Blood-Brain Barrier 2174Arrhythmia 3006 Brain Immunology & Inflammation 1707 Autonomic Neurophysiology 1190 Cellular 3013CNS Autonomic Control Electrophysiology, Voltage-Sensitive Ion Channels 3014CNS Electrophysiology 2175 Electrophysiologic Testing 3007 Cell Therapies in Stroke 3040 Heart failure, Cardiomyopathy & Arrythmias 1195 Cerebral Blood Flow and Metabolism 1200 2176 Mechanisms of Arrhythmias Cerebral Edema and Intracranial Pressure 3039 Non-invasive Risk Stratification 3011 Cerebral Hemorrhage & Hematoma 2178 Pacing & Devices 3008Cerebral Hypoxia 1298 Pharmacology 3009Cerebral Ischemic Pre-conditioning 2177 Physiological Genomics 3010Cerebral Plasticity & Repair 3041 Resuscitation Arrhythmias 1206 Cerebral Vascular Biology 3003 Stem Cell Biology 3012 Clinical Stroke & Cerebrovascular Disease 3015Epidemiology of Stroke 1125 - CARDIORENAL 3016Genetics/Genomics in Brain 3017Mechanisms of Cerebral Ischemic Cell Death 1005Acid-Base Balance, pH Regulation 3018Neurodevelopment 1006Aging 3019Neuroprotection: Focal Cerebral Ischemia 1707 Autonomic Neurophysiology 3020Neuroprotection: Global Cerebral Ischemia & 1171 Cellular & Immunological Mechanisms of Injury Cardiac Arrest 3027 Complications of Chronic Kidney Disease 3021 Perinatal Brain Injury 1296 Cytokines, Chemokines & Other Mediators 3003 Stem Cell Biology 3033 Developmental Programming of Adult CVD 3022Stroke Rehabilitation: Clinical & Experimental 1248 Diabetic & Hypertensive Vascular Renal Disease 3023Technologies in Stroke: MRI, CT, PET, TCD 1133 Divalent Ion Metabolism & Function 3024Thrombosis in Cerebrovascular Disease 1387 Functional Genomics & Proteomics in Renal Disease 3025Traumatic Brain Injury 3031 Gender Differenc es 1396 Growth Factors, Peptide Hormones & Autocoids 3000 - CARDIAC BIOLOGY/REGULATION 1571 Mechanisms of Renal Progression & Salvage 1596 Molecular Genetics of Renal Disease & Development 1006 Aging 3029 Obesity & Metabolic Syndrome 1707 Autonomic Neurophysiology 3032 Pregnancy & Hypertension 1120 Cardiomyopathies 1841 Renal Growth, Differentiation & Angiogenesis 1142 Congestive Heart Failure 3028 Renal Hemodynamics 1276 Coronary Artery Disease 1905 Signal Transduction 1280 Coronary Circulation 3003 Stem Cell Biology 3033 Developmental Programming of Adult CVD 2073 Steroid & Peptide Natriuretic Factors 1297 Exercise Physiology 3030 Steroid Hormones 1360 Experimental & Clinical Hypertension 1932 Structural & Matrix Biology 3031 Gender Differences 1934 Structure Function Correlations in the Kidney 1415 Hemodynamics 1951 Transcriptional & Post-transcriptional Regulation 1653 Hypertrophy 1959 Transporters & Ion Channels 3049 Inflammation 1026 Myocardial Apoptosis 1135 - CARDIOVASCULAR DEVELOPMENT 1625 Myocardial Ischemia 3050 Myocardial Regeneration 1150 Cardiovascular Morphogenesis/Teratology 1024 Myocarditis 1165 Cell Differentiation, Myocyte & Other Lineages 1828 Neurohumoral Control 1167 Congenital Cardiovascular Disease 1661 Nitric Oxide in Myocardial Biology 1285 Coronary/Vascular Development 3029 Obesity & Metabolic Syndrome 1460 Developing Myocardium - Physiology, Pharmacology, 1696 Oxidant Stress Metabolism & Disease 1300 1298 Pharmacology Developmental Electrophysiology 2172 Physiological Genomics 1461 Developmental Molecular Biology 3032 Pregnancy & Hypertension 1305 Developmental Physiology/Pharmacology/Metabolism 1826 Remodeling 3034 Developmental/Morphogenic Signaling 3003 Stem Cell Biology 1380 Fetal and Perinatal Circulation 3030 Steroid Hormones 2072 Genetic Mapping 1962 Valvular Disease 1435 Human Genetics of Congenital CV Malformations 1600 2020 Ventricular Function Molecular Models of Congenital Cardiovascular Malformations 1705Pediatric Cardiovascular Disease 1706Pulmonary Embryology 3003 Stem Cell Biology
  • 29. SCIENCE CLASSIFICATION (3) 1175 - CELL TRANSPORT, PHYSIOLOGY & METABOLISM 1540 - LUNG, RESPIRATION & RESUSCITATION 3038 Biophysics of Ion Channels 1666 Oxygen Transport & Tissue Respiratory Processes 1110 Calcium & Magnesium Transport & Regulation 1779 Pathophysiology, Cell & Molecular Biology of 1169 Cell Biochemistry & Metabolism Pulmonary Edema 2202 Cell Membranes 2195 Pulmonary Endothelium & Nitric Oxide 1168 Cell Volume Regulation 1780 Pulmonary Hypertension 2071 Cellular & Molecular Physiology of Ion Channels 1876 Pulmonary Physiology Pharmacology & Therapeutics 1166 Cellular & Molecular Physiology of Ion Transporters 1790 Pulmonary Vascular Biology 1185 Cellular Cardiac Physiology & Pharmacology 1826 Remodeling 2201 Cellular Fluorescence Imaging 2196 Respiratory Genomics & Proteomics 3035Cellular Vascular Physiology & Pharmacology 1905 Signal Transduction 3036Epithelial Transport 3003 Stem Cell Biology 2203 Excitation Cessation Coupling 1951 Transcriptional & Post-transcriptional Regulation 1350 Excitation Contraction Coupling in Muscle Cells 2076 Intracellular pH Regulation 1605 - MOLECULAR SIGNALING 1585 Mitochondria, Bioenergetics 3037 TRP and Store-Ope rated Channels 2200 Apoptotic Signaling 3066 Calcium Signaling 1475 - IMMUNOLOGY AND MICROBIOLOGY 3070 Caveolae Microdomains 1394 Cytokine Signaling 2186Autoimmune Diseases 3064 G Protein Coupled Receptors 2187Bacteria, Protozoa, Fungi & Viruses 1396 Growth Factors, Peptide Hormones & Autocoids 1315 Cardiovascular Diseases of Immunogenic Origin 1393 3068 Heterotrimeric G Proteins Cytokines 3067 Junctional Signaling 2188 Endocarditis & Myocarditis 2197Kinase & Phosphatase Signaling Cascades 1365 Experimental Organ & Tissue Transplantation 2198Nitric Oxide 1465 Immunochemistry & Immunopathology 3065 Nuclear Receptors 2189 Immunologic Mechanisms in Cardiovascular Diseases 3062Reactive Oxygen Species 1011 Infectious Diseases of the CV System 3063Receptor Tyrosine Kinases 3043 Inflammatory Molecules (Markers & Mediators) 3042 3069 Rho Family Innate Immunity 2199 Second Messengers 1575Microbial Chemistry 1905 Signal Transduction 1576Microbial Genetics 3003 Stem Cell Biology 1577Microbial Pathogenesis 3003 Stem Cell Biology 1805 - RADIOLOGY & IMAGING 1530 - LIPOPROTEINS, LIPID METABOLISM & NUTRITION 1156 Cardiovascular Ultrasound 1806 Computed Tomography 2190Animal Models of Lipoprotein Metabolism 2171 Coronary Angiography & Coronary Interventions 2191Atherosclerosis, Lipoprotein-Related Mechanisms 2074 Echocardiography 3058 Biology of Adipose Tissue 1455 Imaging Technology 3057 Biology of Body Weight Regulation & Obesity 1546 MRI, MRA 3052 Intracellular Cholesterol & Lipid Trafficking 1456 Magnetic Resonance Spectroscopy 3055Lipid & Lipoprotein Metabolism 1457 Myocardial Imaging 3056Lipid & Lipoprotein Oxidation 1671 Nuclear Cardiology 3051 Lipid Efflux & Reverse Cholesterol Transport 1800Radiology 1515 Lipolytic Enzymes & Lipid Transfer 1801Radionuclide Imaging (PET, SPECT & Others) 1520 Lipoprotein Receptors and Lipoprotein - Cell 1807 Vascular Angioplasty & Interventions Interactions 1519 Lipoprotein, Structural 1994 Vascular Imaging Biology, Biochemistry & Biophysics 1940- SURGERY 2194 Metabolic Syndrome, Diabetic & other Dyslipidemias 1680 Nutrition, Physical Activity, Lipids & Atherosclerosis 1025 Anesthesiology 3053 Transcription Factors & Regulation of Lipid & 1569 Interventions/Surgeries Lipoprotein Metabolism 1572 Mechanical Surgical Assistance & Replacement 1635 Myocardial Preservation 1540 - LUNG, RESPIRATION & RESUSCITATION 1755 Postoperative Care (Critical Care) 1900 Shock 1045 ARDS Acute Respiratory Distress Syndromes & Acute 3071 Surgery, Cell Therapies Lung Injury 1015 Alveolar 1941Surgery, Congenital Heart Disease & Airway Function 1942Surgery, Ischemic Heart Disease 3059 Alveolar Fluid Clearance 1943 Surgery, Valvular Disease 1290 CPR (Cardiopulmonary Resuscitation) 1490 2205 Surgical Outcomes Cardiopulmonary Function & Disease 1956 Transplantation, Cardiac 2077 Control of Ventilation 1958 Transplantation, Non-Cardiac 1415 Hemodynamics 1975 Vascular Disease 1654 Hypoxia & Ischemia 3061 Inflammation & Fibrosis 1535 Lung Cell & Molecular Biology 1580 Microcirculation 1597 Molecular Genetics of Lung Disease 3060 Neonatal lung 1697 Oxidant Metabolism & Signaling
  • 30. SCIENCE CLASSIFICATION (4) 1945- THROMBOSIS 1240Clotting Factors & Clotting Inhibitors 1241Coagulation 1385 Fibrinogen 1386 Fibrinolysis 1410 Hematology 1420 Hemostasis 1740 Plasminogen 1750 Platelets 3200 - VASCULAR BIOLOGY & BLOOD PRESSURE/REGULATION 1006 Aging 3075 Angiogenesis 2179 Apoptosis 1707 Autonomic Neurophysiology 1032 Baroreflex Chemoreflex 2017 CNS Control of Cardiovascular Function 1276 Coronary Artery Disease 1280 Coronary Circulation 3033 Developmental Programming of Adult CVD 2180 Endothelial Function 1297 Exercise Physiology 1360 Experimental & Clinical Hypertension 3031 Gender Differences 1415 Hemodynamics 1653 Hypertrophy 3049 Inflammation 1580 Microcirculation 1828 Neurohumoral Control 2182 Nitric Oxide 3029 Obesity & Metabolic Syndrome 1696 Oxidant Stress 1298 Pharmacology 2184 Physiological Genomics 3032 Pregnancy & Hypertension 1826 Remodeling 1905 Signal Transduction 3003 Stem Cell Biology 3030 Steroid Hormones 2185 Vascular Smooth Muscle Function 2010 Vasoactive Agents & Hormones 2000 - VASCULAR WALL BIOLOGY 1035 Angiogenesis & Vasculogenesis 1031 Animal Models of Atherosclerosis & Arterial Injury 1066 Atherosclerosis, Pathogenesis 1056 Cell - Cell Interactions 2206 Diabetes/Atherogenic Mechanisms 1330 Endothelium Structure and Function 1550 Macrophage Biology 1910 Smooth Muscle Cells 3003 Stem Cell Biology 1991 Vascular Cell Apoptosis 1970 Vascular Cytokines 1980 Vascular Extracellular Matrix & Cell Adhesion 1981 Vascular Growth Factors 1662 Vascular Reactivity 3080 Vascular Wall Developmental 2005 Vascular Wall Mechanics
  • 31. PERSONAL DATA The American Heart Association (AHA) is committed to monitoring the operation of its review and award processes to detect, and the deal with appropriately, any instances of real or apparent inequities with respect to age, gender, race or ethnicity of its applicants. The following information will enable us to honor this commitment. Upon receipt of the application by the AHA, this form will be separated from the application. The form will not be duplicated, and will not be a part of the review process. Data will be confidential. All analyses conducted on the data will report aggregate statistical findings only and will not identify individuals. If you decline to provide this information, it will in no way affect consideration of your application. Your cooperation will be greatly appreciated. 1. Applicant:                       First Middle Last Jr, III, etc 2. Social Security Number:       3. Date of birth:       mm/dd/yyyy 4. Gender: Male Female 5. Race and/or ethnic origin (place an X in the most appropriate box): (Note: For purposes of reporting mixed racial and/or ethnic origins, the category that most closely reflects the individual’s recognition in the community should be used.) Alaskan Native A person having origins in any of the original people of North America, and who maintains cultural identification through tribal affiliation or community recognition. American Indian A person having origins in any of the original peoples of the Far East, Southeast Asia Asian or the Indian Subcontinent. This area includes, for example, China, India, Japan, Korea, etc. A person having origins in any of the original peoples of the islands of the Pacific. Th Pacific Islander includes people of Polynesian, Samoan or Micronesian heritage. Black, not of Hispanic Origin A person having origins in any of the black racial groups of Africa. A person of Mexican, Puerto Rican, Cuban, Central or South American or other Hispanic Spanish culture or origin, regardless of race. A person having origins in any of the original peoples of Europe, North Africa, or the White, not of Hispanic Origin Middle East. The following information is requested for program evaluation purposes. Data will be reported in aggregate statistical form only. 6. Do you have tenure? Yes No Not Applicable Tenure Year:      

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