Early Career Scientist (yes/no) 3. Project Partners: 3a. Additional research partners asking for funding: Type of Institution, entity Type of entity Zip Department, full Early Research Partner Academia, code, affiliations Email Career No. (principal Clinical or City, (address, phone address Scientist* investigator) Public Country + fax) (yes/no) Health, SME and Industry 1 2 3 4 5 (only possible with inclusion of 1 partner from 6 usually underrepresented countries) (only possible with inclusion of 2 partners from 7 usually underrepresented countries) 3b. Associated research partners not asking for funding (see table in the Call text for the maximum number of partners): Type of Institution, entity Type of entity Research Department, full Early Zip code, Academia, (public / Partner affiliations Email Career No. City, Clinical or private-for-profit (principal (address, phone + address Scientist Country Public / investigator) fax) (yes/no) Health, SME or Industry 1 2 3c. Patient advocacy organisation (PAO) partners asking for funding: Organisation, full Zip code, Type of entity (public affiliations (address, No. City, Responsible person Email address / phone + fax) Country
Early Career Scientist (yes/no) 3. Project Partners: 3a. Additional research partners asking for funding: No. Zip code, City, Country Research Partner (principal investigator) Institution, Department, full affiliations (address, phone + fax) Email address Early Career Scientist* (yes/no) Type of entity Academia, Clinical or Public Health, SME and Industry Type of entity 1 2 3 4 5 6 (only possible with inclusion of 1 partner from usually underrepresented countries) 7 (only possible with inclusion of 2 partners from usually underrepresented countries) 3b. Associated research partners not asking for funding (see table in the Call text for the maximum number of partners): No. Zip code, City, Country Research Partner (principal investigator) Institution, Department, full affiliations (address, phone + fax) Email address Early Career Scientist (yes/no) Type of entity Academia, Clinical or Public Health, SME or Industry Type of entity (public / private-for-profit / 1 2 3c. Patient advocacy organisation (PAO) partners asking for funding: No. Zip code, City, Country Responsible person Organisation, full affiliations (address, phone + fax) Email address Type of entity (public /
aap-ejp-rd-2019-Pre-Proposal-Form.docx