APPLICATION FORM
SIGMA THETA TAU XI CHAPTER RESEARCH GRANTS
Next Deadline:
Monday, February 11, 2008
ATTENTION: All Xi Chapter Research Grants will now be submitted ONLINE! Please follow the instructions below.
Those awarded grants must attend the Induction Ceremony on May 18th 2008
1. Title of study:
2. Name(s) of Applicant(s) + Credentials::
Applicant's Home/Business Address:
Applicant's Telephones:
Home:
Business:
E-mail Address:
Include a copy of the Curriculum Vitae or Biographic Sketch of each investigator in the Appendix to this grant application.
3. Is the Applicant a member in good standing of the
Xi Chapter of
Sigma Theta Tau at the time of this application?:
Yes: ______No:____________ Member Number: _________________
4. Have you applied for or are you now receiving support for this research?
Yes: _________ No: ________
If yes, please list source(s) of funding and amount requested:
Source(s) of funding:
Amount(s) requested/funded:
If funding decision pending, date(s) of notification:
If other support is received after this application is submitted, please notify the Xi Chapter Research Committee Chairperson (Chris Coleman)
5. Has this application been submitted for Human Subjects (Institutional Review Board) approval?
Yes:_________ No:_________ (explain)
If yes, which institution(s)?
If Human Subjects approval has been granted, include the approval form in the Appendix to the grant application.
6. Please complete if Principal Investigator is a student:
University and school or department:
Degree sought:
Expected date:
Major:
Names of Research Advisors/Dissertation Committee members:
FORMAT FOR PROPOSAL:
1. Title and Abstract
The first page of the proposal includes the title and a 150 word abstract. The abstract is to include the specific aims of the research, methodology (including design, sample, instruments), and data analysis procedures.
2. Budget
List amount and provide justification for major expenditures. If the proposed study is going to be funded by multiple sources, the entire budget for the research study must be included. Indicate those items for which for which Xi Chapter, Sigma Theta Tau funding is requested. Prioritize items for Xi Chapter funding. Funding may be requested from Xi Chapter for the following items:
a. Personnel (Please note that Principal/Co-Investigator(s) salaries cannot be included in the budget.)
b. Consultants
c. Supplies
d. Equipment
e. Local Travel (Xi Chapter research fund is not sufficient to support travel to professional meetings.)
f. Other Expenses (Itemize)
3. Research Plan
Do not exceed 10 single-spaced or 20 double spaced typewritten pages for a-d. All type must be 12 pitch or larger. Minimum of 1 inch margins on all sides.
a. Specific Aims: State concisely and realistically what the research described in this proposal is intended to accomplish and/or what questions/hypothesis(es) is/are to be answered/tested. Do not exceed one single-spaced or two double-spaced pages.
b. Background and Significance: Briefly describe the background to the present proposal, critically evaluate existing knowledge, and specifically identify the gaps that the research is intended to fill. Identify and briefly describe the theoretical model upon which the research is based. Provide theoretical definitions for study variables. State concisely the importance of the research by relating the specific aims to longer term objectives. Do not exceed three single-spaced or six double-spaced pages.
c. Preliminary Work: If applicable, describe the investigator's preliminary studies pertinent to the proposed research.
d. Design and Methods: Discuss in detail the design and methods to be used to accomplish the specific aims of the research. The description of the design should identify the type of research proposed (e.g., descriptive, experimental, longitudinal, cross-sectional). The description of methods should include the following areas:
(1) Sample characteristics and size. Describe the characteristics of research subjects and sampling criteria. Provide a rationale for the sample size. Indicate how subjects will be recruited.
(2) Instruments. Identify each instrument to be used and state which study variable will be measured by each instrument. Discuss validity, reliability, and scoring procedures for each instrument. Include a copy of each instrument in the Appendix.
(3) Data collection procedures. Describe the procedures to be used for data collection. Indicate when and how informed consent will be obtained from subjects.
(4) Data analysis plan. Describe the data analysis procedures to be used for each specific aim/question/hypothesis.
(5) Time table. Provide a time table for each phase of the research.
(6) Human subjects considerations. Indicate if the study has been approved by the appropriate Human or Animal Subjects Committee(s). Include letters of approval and a copy of the consent form (if applicable) in the Appendix.
4. Facilities and Resources
List the facilities to be used for the research and the resources available to the investigator(s). Include letters granting access to study populations in the Appendix.
5. Literature Cited
List only those works cited in the research plan.
6. Appendix
Include Curriculum Vitae or Biosketches of all investigators and consultants, consent form(s), instruments, human subjects approval(s), and letters of support from consultants and data collection sites (if any). Letters attesting to the ability of the investigator(s) to conduct the research also may be included.
__________________________________________________________________________________________________________
The section below is to be completed by the Xi Chapter Research Committee Chairperson:
Approval date:_____________
Amount of award:_____________
Progress report(s) received (list date(s)):_____________
_____________
_____________
_____________
Date of study completion:_____________
Funds used:_____________
Funds returned:_____________
Final report date:_____________
Xi Chapter Research Committee Chairperson:_______________________
__________________________________________________________________________________________________________
INSTRUCTIONS FOR SUBMISSION:
1. CUT AND PASTE THIS APPLICATION AND PROPOSAL FORMAT ABOVE INTO MICROSOFT WORD AND SEND VIA EMAIL ATTACHMENT TO: Chris Coleman (colemanc@nursing.upenn.edu)
2. APPLICATIONS MUST BE RECEIVED NO LATER THAN MONDAY, FEBRUARY 19, 2007. YOU WILL RECEIVE AN E-MAIL CONFIRMING THAT WE HAVE RECEIVED YOUR APPLICATION.
3. ALL LETTERS OF SUPPORT MUST ALSO BE SUBMITTED TO Chris Coleman. (If signed electronically) PLEASE ASK INDIVIDUALS TO SEND THEM IN AN EMAIL OR BY EMAIL ATTACHMENT NO LATER THAN FEBRUARY 19, 2007. IF YOUR LETTER CANNOT BE SIGNED ELECTRONICALLY OR SENT BY EMAIL DIRECTLY TO XI CHAPTER, THEN YOU MUST SUBMIT THEM WITH THE RESEARCH GRANT AGREEMENT TO THE 4TH FLOOR SIGMA THETA TAU, XI CHAPTER MAILBOX BY THE DEADLINE. THESE SAME PROCEDURES SHOULD ALSO BE APPLIED FOR LETTERS FROM DATA COLLECTION SITES.
4. PRINT THE RESEARCH GRANT AGREEMENT BELOW AND OBTAIN SIGNATURES. THIS FORM SHOULD BE PLACED IN THE 4th FLOOR SIGMA THETA TAU XI CHAPTER MAILBOX BY NO LATER THAN 5:00 PM ON FEBRUARY 19, 2007. ****NOTE THAT THERE IS A LINK TO THE XI CHAPTER RESEARCH GRANT PROGRESS REPORT IN THE INSTRUCTIONS BELOW FOR THE RESEARCH GRANT AGREEMENT (3). MARK YOUR CALENDARS! NO EXCEPTIONS WILL BE MADE. THIS PROGRESS REPORT SHOULD ALSO BE SUBMITTED TO Chris Coleman VIA EMAIL ATTACHMENT.
__________________________________________________________________________________________________________
RESEARCH GRANT AGREEMENT
SIGMA THETA TAU XI CHAPTER RESEARCH AWARDS
If this proposal is approved for funding, I (we) agree to the following conditions:
1. Accept responsibility for the scientific conduct of this study.
2. Expend the funds as described in the proposal, deposit all funds by June 15, and return unused funds to the Treasurer of Xi Chapter.
3. Submit a progress report annually until the study is completed. Please note: Starting May 2003, all grantees will be expected to submit the Xi Chapter Research Grant Progress/Final Report. This report will be due on May 1st of each year annually until the study is completed. This progress report should be submitted online via email to Chris Coleman (colemanc@nursing.upenn.edu).
4. Acknowledge the grant support of Xi Chapter of Sigma Theta Tau in any publications and/or presentations of the research findings.
5. Publish or present the findings of the research in a program sponsored by Xi Chapter if invited to do so.
Principal Investigator Signature: Date:
___________________________________________________________________________________________________
Co-Investigator Signature(s) (all must sign): Date:
___________________________________________________________________________________________________
Expected date of start of data collection:______________________
Expected date of final progress report:________________________
Name to whom the check should be written if you are to receive this award:__________________________________
__________________________________________________________________________________________________________
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