Office of Research

960 East Third Street, Suite 104

Chattanooga, TN 37403

(423)778-6884 Fax (423)778-3673

GRANT REQUEST FORM

PI name(s):
PI phone number(s):
PI email(s):
PI Department(s):
Title of grant/proposal:
Estimated total budget:
Due Date for Grant Submission (for funding Agency):
Please give a Project Narrative (no more than 2 or 3 sentences; describe the relevance of this research to public health; be succinct and use plain language that can be understoodby a lay audience)
List Key Personnel [for example: co-Investigator(s); Coordinator(s); Administrator(s); Graduate Student(s), etc.]

Are adequate funds and personnel available for support? Yes No

______
GrantwriterDate Received

______
Principal Investigator (PI)Date

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Dean, College of MedicineDate

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Research DirectorDate

SPECIFIC DOCUMENTS & CONTENT CHECK-LIST

Yes
No
NA / Abstract / Project Summary
Should contain most critical background and methodology information
Meant to serve as a succinct and accurate description of the proposed word when separated from the application (state the application’s broad, long-term objectives and specific aims, making reference to the mission of the agency.
No longer than 30 lines of text; use Helvetica, Georgia, Arial, or Verdana; font size should be no smaller than 11
Yes
No
NA / Project Narrative
Should be no more than 2 or 3 sentences
Describe the relevance of this research to public health; be succinct and use plain language that can be understood by a general lay audience.
Yes
No
NA / Biosketches
Must be submitted in NIH format (see attachment)
Must include all personnel accounted for in proposal / project / study
Yes
No
NA / Research Plan
Specific Aims / Hypotheses
  1. State hypothesis to be tested
  2. List specific aims in decreasing order of importance
  3. Specific aims can be subdivided into primary and secondary aims, if necessary
Background and Significance
  1. Should be thorough and clearly cover the current literature in the area to be studied
  2. References are required for all work cited
  3. This section should end with a description of how the proposed study will add to the current body of knowledge
Preliminary Work / Studies
  1. Any work done by the current investigators relevant to this study should be included here
  2. Many investigators will leave this section blank for a new area of study
Research Design & Methods
  1. Study Design
  2. Describe the study design
  3. Give rationale for choosing the study design
  4. Study Subjects
  5. Describe process of subject selection
  6. Inclusion criteria
  7. Exclusion criteria
  8. Process of control selection, if using controls
  9. Sample Size
  10. Explain total number of subjects to be tested
  11. Include statistical methods used to determine adequate sample size
  12. If local subject numbers are insufficient, describe plan to address suboptimal sample size (partnership with other researchers, increased recruitment area, etc.)
  1. Data Collection
  2. Define data points to be collated
  3. Describe which data points represent study outcome variables
  4. Include any forms to be given directly to subjects exactly as will be used in the study
  5. Include form to be used for investigator collection of data
  6. If laboratory techniques are to be used, describe in detail
  1. Data Handling
  2. Describe how data will be collected and stored
  3. Explain steps taken to assure accurate and complete data collection
  4. Describe steps taken to ensure security of any confidential information to be collected during study
  5. Data Analysis
  6. Explain detailed plan for analysis of data
  7. Descriptive statistics to be used
  8. How will analysis performed test study hypothesis?
  9. Expected formats for presenting results
Time Frame
  1. Detailed and realistic time frame for subject recruitment and participation
  2. Time frame for completion of entire study (including analysis)
Strengths/Innovations
  1. Describe the strengths of the study proposal
  2. Describe specifically how this study/project will enhance the current body of knowledge
Limitations
  1. Describe potential problems that may arise and plans to address these problems
  2. Describe potential confounding variables in the study and plans to account for the confounders

Yes
No
NA / Risks and Benefits to Human Subjects, Animal Care, Hazardous Materials
For projects involving human subjects, must have narrative describing one or more of the following:
  1. Protection of human subjects
  2. Inclusion of women and minorities
  3. Targeted/planned environment
  4. Inclusion of children
  5. Inclusion of prisoners
If animals will be used, provide detailed plans describing number of animals, plans for the care and disposal of the animals
If hazardous materialswill be used, describe detailed plans for safe use, storage, and disposal of materials.
Discuss ethical concerns involved in conduct of the proposed study
Yes
No
NA / Other research plan sectionsmay require document justifying one or more of the following:
Select Agent Research
Multiple PI Leadership Plan
Consortium / Contractual Arrangements
Letters of Support
Resource Sharing Plan(s)
Yes
No
NA / Budget / Research Environment – (i.e., facilities, clinical space, etc.)
List total cost to be incurred to complete study / project, such as: personnel, facilities / space, equipment, supplies, etc.
Identify source of funding for study conduct
If multiple areas of cost to study, itemize budget as appropriate
Yes
No
NA / Equipment
List major items of equipment already available for this project and, if appropriate, identify location and pertinent capabilities.
Yes
No
NA / Supplies
List total funds requested for materials and supplies. In the budget justification, indicate general categories such as glassware, chemicals, animal costs, including an amount for each category. Categories less than $1,000 are not required to be itemized.
Yes
No
NA / Facilities
Identify the facilities to be used (Laboratory, Animal, Computer, Office, Clinical and Other). If appropriate, indicate their capacities, pertinent capabilities, relative proximity and extent of availability to the project
  1. Describe only those resources that are directly applicable to the proposed work.

Yes
No
NA / References
List relevant literature to the proposed study / project
Each reference must include: names of all authors (in the sequence in which they appear in the publication), article title, journal or book title, volume number, page numbers, and year of publication. Include only bibliographic citations.
Yes
No
NA / Appendices
Data Collection Form
Any survey or measurement tool to be given directly to the subjects
Previous publications of preliminary work, if any:

Grant Request Form / Specific Documents & Content Check-List