Medical Writing Grant Application

Medical Writing Grant Application

Instructions

This form must be completed by the submitting author. All applications will be reviewed by Apellis based on medical or scientific merit, unmet medical need, and availability of funds. Apellis reserves the right to award grants based on its sole discretion.

Please allow at least four weeks for review of any application. This application and the checklist must be filled out in order for the grant to be evaluated.

Please direct any questions to: medicalresearch@apellis.com

Publication Information

Name*

Email*

Affiliated Instituion*

Street Address*

City/Province*

Country*

Zip Code*

Publication Title*

Description of Publication.*

Please include information on why this publication would be of value to the medical community. Please include any relevant details or information such as proposed type of publication, anticipated submission date, or targeted journal/audience.

Description of Support Requested*

Priority would be to provide support in the form of medical writing through a third-party agency. Direct financial support would be considered only in the case of direct support of a publication (i.e. open-access fees for manuscripts or other direct publication costs).

Authorship Requirements

Apellis supports publications that meet the criteria of the "International Committee of Medical Journal Editors (ICMJE) Recommendations for the Conduct, Reporting, Editing and Publication of Scholarly Work in Medical Journals" as well as Good Publication Practice for Communicating Company-Sponsored Medical Research (GPP3) guidelines. Please complete this form to confirm that your publication will meet this criteria:

ICJME Criteria:

Please confirm that you and your authors intend to satisfy the ICMJE’s criteria below for this work.

Contribute to the conception or design of the work; or the acquisition, analysis, or interpretation of data for the work?*

Yes

Draft the work or revise it critically for important intellectual content.*

Yes

Approve the final version to be published?*

Yes

Agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved?

Yes

Sunshine Reporting

Pursuant to Apellis policy, Apellis does not provide financial compensation for authorship of publications, including clinical trial manuscripts, abstracts or review papers. However, authors should be aware that pursuant to the “Sunshine” provisions of the Patient Protection and Affordable Care Act, Apellis is required to report costs associated with editorial/writing support (“publication support”) as a transfer of value, when that support is provided to a US-licensed physician or teaching hospital. As an author of an Apellis-supported publication, if you receive publication support, the value of this support will be reported to the Centers for Medicare and Medicaid Services (CMS), as required by law.

Please confirm that you and your fellow authors have read and understand the Apellis policy regarding “Sunshine” reporting.

Yes I understand Apellis is required to report costs associated with editorial/writing support(“publication support”) as a transfer of value*