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Application Form for 2022 Milo Hellman Research Award, Harry Sicher Research Award and Thomas M. Graber Award of Special Merit

Please check the appropriate option:
- I am an AAO member and a graduate student, resident or PhD candidate.
- I am an AAO member. I graduated with a Certificate, Masters or PhD from an orthodontic program between November 2020 and October 2021.
- I am an AAO member in the United States.
- I am an AAO member in Canada.
- I am affiliated with an ADA or CDA accredited orthodontic program serving as a full-time teacher or researcher.
NOTE: If you selected Option 1 or 2 above then you must state the program director's name and email below. If program director's name and email boxes are left blank then you will only be considered for a Hellman.
Department or Program Director Name: (if applicant is a graduate student/resident)
Department or Program Director Email:
Title*
Abstract:*
Author*
The applicant must be the primary author of the submitted research
Degrees*
For example: DDS, MS
Contact Information
Please provide a mailing address, telephone number and an email address that will be valid after January 1, 2022.
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Telephone*
Applicant Email*
Award Submission
Institution where work was done (if applicable):
Was the research for this application completed for:*
Has your part of this entry been submitted before for a Hellman, Sicher, Graber Award?*
Has your entry previously been published in a journal?*
If yes, provide bibliographic citation for article:
Has your entry been submitted to a journal for publication?*
If yes, provide journal title where article has been submitted:
I am the first author listed on this research being submitted for the Hellman, Sicher, Graber Award and I will be the first author on any other subsequent publications from this research?*
This submission predominately represents my individual effort?*
IRB or IACUC Approval
Did the research need IRB or IACUC approval?*
If yes, supply the IRB or IACUC approval number below.
IRB approval number for human subject protection:
IACUC approval number for animal research:
You do not need to submit a hard copy of the IRB or IACUC approval with your application.
Application Uploads
Please be aware that any material you upload as part of your Hellman, Sicher, Graber application becomes the property of the American Association of Orthodontists. An electronic copy of the research will be placed in the online catalog of the AAO Library.
Upload Biographical Sketch:
Upload completed biographical sketch here.
Accepted file types: gif, jpg, png, pdf, doc, docx, ppt, pptx, xls, xlsx, xml.
Upload Attestation Statement:
Upload completed attestation statement here.
Accepted file types: gif, jpg, png, pdf, doc, docx, ppt, pptx, xls, xlsx, xml.
Upload Research:
If you are submitting a published article to be considered for the Milo Hellman Research Award, DO NOT upload a PDF copy of the published article. Upload a copy of the document you submitted to the publisher.
Accepted file types: gif, jpg, png, pdf, doc, docx, ppt, pptx, xls, xlsx, xml.
Upload PRISMA statement or CONSORT form, if needed:
Accepted file types: gif, jpg, png, txt, pdf, doc, docx.
Electronic Signature and Date
I confirm that all the requested materials are included; that I have read the award application; and that I am eligible for the Milo Hellman Research Award or the Harry Sicher Research Award or the Thomas M. Graber Awards of Special Merit, if my research is selected. I have read and agree to all conditions stated on the online application.
Applicant's Signature:*
Electronic signature form example: /s/ Jane Doe
Date
Date Format: MM slash DD slash YYYY

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Application Form for 2022 Milo Hellman Research Award, Harry Sicher Research Award and Thomas M. Graber Award of Special Merit

Contact Information

Award Submission

IRB or IACUC Approval

Application Uploads

Electronic Signature and Date