Application for Research Grant
Posted on November 1st, 2007

CHECKLIST FOR RESEARCH GRANT APPLICATIONS

Before submission please ensure that your proposal includes the following:

1. Application Information
2. Abstract (one sheet)
3. Summarized Curriculum Vitae (up to four typewritten pages)
4. Research Plan and Narrative (not to exceed 10 pages of 12 pitch type face):
   1. Specific Aims (a realistic and concise description of what the research intends to accomplish and a statement of the research hypotheses and/or questions). . Significance (a brief, but critical evaluation of relevant existing knowledge, and a clear discussion of relationship to the proposed research.)
   2. Statement of relevance and ultimate impact on future funding potential and collaboration between Peoria NEXT and other Institutions.
   3. Preliminary data, if applicable. . Methods (the experimental design, strategies for measurement and data analysis, project timeline)
5. Bibliography: Literature cited (not to exceed 3 pages; citations should be relevant to project)
6. Accountability Form: Signed by the Principal Investigator (sheet provided in packet)
7. Permission of Applicable Oversight Bodies (funding not be released until IRB/IACUC approval letter has been received)
   1. Copy of completed IRB/IACUC application.
   2. IRB/IACUC application has been submitted for approval.
   3. IRB/IACUC Approval Letter.
8. Suggestion of external reviewers: List, including institutional affiliation, six to ten individuals who might serve as reviewers for your proposal. Should not be colleagues with whom you have collaborated within the past five years or with whom you have a mentoring or working relationship, i.e. avoid a conflict of interest in the review of your proposal.

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APPLICATION FOR RESEARCH GRANT

Project Title:

PROJECT INVESTIGATOR INFORMATION

Name:

Address 1:

Address 2 (opt):

City:

State:

Zip:

Email:

Telephone:

Location of Research:

Proposed Grant Period:

Collaborators:

Are human subjects involved?  yes no

Are animals involved? yes no

Is an Investigational drug involved? (Pending if yes, provide copy of assurance) yes no

Inter-Institutional Intellectual Property Agreements in place? yes no

Budget Total:

DETAILED BUDGET AND JUSTIFICATION

Equipment (itemize):

For equipment greater than $499, will there be an ongoing use for that equipment at the completion of the project? (Describe)

Salaries (including fringe benefits):

Services:

Other Expenses:

Other funding source received by Proncipal Investigator:

TOTAL:

ACCOUNTABILTY FORM

Project Title:

Expected Activation Date:

Name of Principal Investigator:

If awarded funding for this proposed project, I will provide the required final progress report by the dates specified in the application guidelines. If I fail to do so, I understand that I may be precluded from future Peoria NEXT funding.

I understand that as the principal investigator I am the responsible party for all aspects of study compliance and conduct. During the conduct of this study, I will follow all policies and procedures governing the conduct of clinical research on human subjects, including the Code of Federal Regulations for Protection of Human Subjects, the IRB, Department of Health and Human Services (DHHD), and the Food and Drug Administration (FDA) Regulations. I also agree to comply with any additional policy and procedures in place at:

DEPARTMENT CHAIR/DIRECTOR/DIVISION CHIEF APPROVAL

I have read and approved the above project for submission for funding to the Peoria NXT Granting Program. If the study is funded and undertaken, I will assist the principal investigator in monitoring this project and ensure that policies and procedures which govern the conduct of clinical research on human subjects, including the Code of Federal Regulations for Protection of Human Subjects, the IRB, Department of Health and Human Services (DHHS), and the Food and Drug Administration (FDA) regulations, are followed.
Typed name:	Date:
Typed name:	Date: