Research Grant Application Form

Please do not use all capital letters in this application.

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Projected Dates of Project:  We realize that you may not have precise dates at this time.  Your best guess will suffice.



PRINCIPAL INVESTIGATOR/PROJECT TEAM LEADER (PI)






(555 555 5555)

IF THERE ARE ADD'L PEOPLE ON YOUR TEAM - YOU MAY LIST UP TO 5 TOTAL

FIRST Team Member/Investigator








SECOND Team Member/Investigator









THIRD Team Member/Investigator








FOURTH Team Member/Investigator








FIFTH Team Member/Investigator








AFFILIATED HOSPITAL/INSTITUTION INFORMATION







MAILING ADDRESS FOR PAYMENT OF GRANT






MAILING ADDRESS FOR PAYMENT OF GRANT








INSTITUTIONAL OFFICIAL (IO)

If there is an Institutional Official (IO), who should receive copies of funding approval and report requests?









If you have a Project Mentor, please enter the information below:















PROPOSAL:

Please complete the following proposal. Use the APA format for references, citing the author and publication year in parentheses. For example, (Smith and Jones, 2012.) Then detail your references on an attachment. 

 

To determine the number of words you are using, type in a Word document first and use word count.  Then copy/paste into the form below.



NOTE ABOVE:  Summarize the main points of the grant proposal (aims, methods, outcome measures).



NOTE ABOVE:  Briefly describe the background of your proposal, including:

 

  • A critical evaluation of the existing body of knowledge about the problem. 
  • Identify the importance of this study by relating it to existing knowledge. 
  • Summarize how the proposed research addresses the priorities of the J. Patrick Barnes Grant program.
  • Include a list of references as an attachment (upload explained below).

 



NOTE ABOVE:  Your aims or hypothesis should be specific (Example: Less strong: we want to determine if a patient/family education program works - Stronger: Determine if there is an improvement in patient/family satisfaction with discharge education after implementation of a computer based medication education program).



NOTE ABOVE:  The following are required for this section: 

 

  • Detail the methods you will use for the research. 
  • Identify your sample (characteristics, sample size, provide power analysis as appropriate to justify your sample size). Explain the difficulty or ease you believe you'll have recruiting your sample and why you feel this way.
  • Specify the protocols and instruments you will use. If you are using a particular instrument, provide a copy as an attachment. As appropriate, provide information on the psychometric properties of the instrument you are proposing to use. Please be sure you have already obtained permission to use your tools so that this study is ready to implement once your IRB has approved it and we have agreed to fund it. 
  • Describe outcome variables in detail. 
  • Describe your proposed data analysis plan.
  • Please explain how you will maintain confidentiality. 

 






NOTE ABOVE: Describe in detail how clinical/staff nurses will be involved in this study. E.g. in conceptualization, data collection, analysis, reporting. This is a very important component of your proposal.


Timeline:  Detail your proposed step-by-step timeline, following this example. Your plan should not exceed 12 months.

Proposed Study Duration:

Example: 12 months

Time Frame (Weeks)

Task

Example: Weeks 1-6

Prepare and print all study materials

Example: Weeks 7-20

Recruit eligible participants

Example: Weeks 21-30 

Collect data

Example: Weeks 30-52

Data analysis and preparation of final report

Example: Week X

Progress report due to DAISY Foundation

Example: Week Y

Final report due to DAISY Foundation

Your Timeline:

Create a spreadsheet identical to the one above to present your project’s timeline.  Please upload your timeline at the end of this application. 


Proposed Budget:   Funds are available for direct expenses only. Institutional overhead may not be included. Provide budget using the following chart on an Excel spreadsheet, and describe/provide justification for how you will use the grant funding to support your project (e.g., cost for reproduction of booklets - 500 booklets @ $2/booklet = $1000).  If the funding level offered by The DAISY Foundation is not adequate for your project, please email bonniebarnes@DAISYFoundation.org to discuss.

Budget Item Requested

Detail

Cost

Justification: Why this is needed

Example:

Reproduction of  booklets

500 booklets @ $2.00

$1,000

This is for the family education piece whose effectiveness we are studying

Example:

Supplies

Paper and copying

$250

 

Example:

Statistician

To analyze data and prepare final report.

10 hours @$50 per hour

$500

Professional statistical help required to ensure integrity of findings

Your Budget:

Create a spreadsheet identical to the one above to present your project’s budget.  Please upload your budget at the end of this application. 


DOCUMENTATION – Upload the documents listed below. Your Application Number must be on every page of every document. (Please save your documents using the following simple naming convention for each one you upload: JPB-xxx-A Budget or JPB-xxx-A  Timeline, JPB-xxx-A Interview Guide, JPB-xxx-A Tool permission, etc.):

-  Timeline

-  Budget

-  Tools or instruments you are using

-  Permission to use the tools or instruments

-  Letter of Agreement (see below)

-  Consent Forms - if consent forms are required for IRB approval, they must be submitted with this application

-  Interview formats, discussion guides, etc.

-  References (detail the sources of your assumptions and literature review)

-  For Research grants, Applicant's CV. Please highlight funded and unfunded studies and EBP projects.

-  For EBP grants, Applicant's resume or CV. Please highlight funded and unfunded studies and EBP projects.

If you have a Mentor, the Mentor's biosketch or abbreviated CV. This should include the Mentor's accomplishments/experience/academic training as they relate to this project. 

Proof of IRB approval or letter of exemption if you have it. If you do not have input from your IRB, you may apply and provide the approval prior to DAISY's funding of the grant.

 



LETTER OF AGREEMENT: Please copy and paste this onto your institution’s letterhead.  Fill in the blanks, print it out and sign it. Your Chief Nursing Officer or other Senior Administrator's signature is also required as an indication of her/his support of your work.  

Then scan it into your computer, and upload with this application.  Your application is not complete without this document.

I, __________________________________________, Team Leader/Project Leader/Principal Investigator of the  project entitled _________________________________________________, commit the following to The DAISY Foundation in return for funding I request of $____________:

  • That funds will be used only for direct expenses as detailed in the budget provided in my application
  • That I will inform The DAISY Foundation of the actual start date of this study
  • That a check for any unused funds will be sent to The DAISY Foundation within 90 days of the project’s completion
  • That I will communicate in writing to The DAISY Foundation if my project is terminated before completion
  • That an interim report will be submitted 6 months after funding and a final report submitted within 90 days of the project’s completion. Reports will be submitted through The DAISY Foundation's website.
  • That the report of my study may be posted on The DAISY Foundation website, if the Foundation chooses to do so.
  • That the DAISY Foundation is permitted to use my name/those of my team members and institution and the title and summary of my study in their marketing materials to help promote the grant program. 
  • That I will submit my study to the Virginia Henderson Library of Sigma Theta Tau International within 30 days of filing my final report with The DAISY Foundation.
  • That I will credit funding from The DAISY Foundation upon publication/presentation of this research, using the authorized DAISY Foundation logo to be provided by The Foundation.
  • That The DAISY Foundation may not be held liable for any risk to the subjects of this study.

 

 

Signed __________________________                            Date_______________

 

FOR YOUR CHIEF NURSING OFFICER OR OTHER SENIOR ADMINISTRATOR:

I fully support __________________________________, Principal Investigator of the study entitled ___________________________________________________ in her/his implementation of this project. 

Furthermore, I attest to the fact that clinical or staff nurses will be involved in this study, as described in the application.

Signed__________________________________________________

Title____________________________________________________

Date___________________________________________________


If you have trouble submitting and get an error message, please check to be sure your phone numbers follow the prescribed format (555-555-5555) and that all required fields (noted with an asterisk) are completed. 
 


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