American federation for aging research 55 West 39th Street, 16th Floor, New York, ny 10018 [phone]

Section 4 is NOT to be included in the application.

DO NOT INCLUDE THIS INSTRUCTION SHEET WITH YOUR APPLICATION!

2017 Glenn/AFAR Scholarships for Research in the Biology of Aging

Application
[Cover page: should be the first page of your application]
Title of Proposal (cannot exceed 20 words):

Dates of Proposed Research (the project start date must be between May 1, 2017 and December 31, 2017):

Name, Address, Telephone, and Email Address of Applicant:	Signature Date of Birth Country of Citizenship
Permanent Address, Telephone, and Email, if different from above:	Check the appropriate box: PhD degree anticipated in (Month/ Yr.) MD degree anticipated in (Month/Yr.) MD/PhD degrees anticipated in: (Month/Yr.)
Name, Title, Institution, Complete Mailing Address, Telephone, and Email of Mentor:	Signature of Mentor Date

Does the research plan include use of human subjects? YES  NO
Does the research plan include use of animal subjects?  YES NO
Applicants should note that IRB certification (for human subjects) and/or Animal Use Committee approval (for animal subjects) must be provided to AFAR before a grant award can be made.
Applicants are urged to consult the AFAR website at http://www.afar.org/research/funding/animal-use/ for advice on human and animal usage. The website includes a helpful set of guidelines for optimal use of rodents in aging research projects.