Community Based Research Fellows Application Form

Community Based Research Fellows
Request for Proposals

COMMUNITY BASED RESEARCH FELLOWS APPLICATION FORM

Faculty Applicant Name:

MSU Denver E-mail: @msudenver.edu

Academic Department: Office Phone:

****************************************************************************************

1.  Project Description

Please attach a description of the community-based research project for which you are requesting funding. (Be sure to see the information sheet for criteria.) Please include:

a)  The semester you will conduct the research project

b)  The name of the student researcher

c)  A written endorsement from the community partner

d)  Project Abstract: a brief overview of your proposed project. Indicate how the CBR project contributes to the faculty member’s scholarship, deepens the student’s learning, and builds the community partner’s capacity.

e)  Budget: a general description of what you will use the grant money for and how much each item costs

f)  A copy of IRB approval (if necessary) must be provided before research begins and funds are dispersed.

2.  IRB Approval

Will your project involve research with human subjects? ______Yes ______No

a)  If yes, please initial the box below to affirm that you will ensure that your project follows the procedures MSU Denver’s IRB has set forth. Furthermore, initialing indicates that you understand grant funds will be released only after you have provided documentation to the Service Learning Program verifying that the project has received approval from MSU Denver’s IRB. (http://www.msudenver.edu/irb/).

b)  If applicable, you must provide documentation that certifies that you and each student who will participate in the service learning project have completed the appropriate CITI training described on MSU Denver’s IRB web site before you will receive funds from the grant. (http://www.msudenver.edu/irb/gettingstarted/citiprogramtraining/)

Please initial the box below to affirm that you understand and accept this condition.

3.  Property Purchased with Grant Money

All property purchased with this grant money is the property of MSU Denver and not of the community partner with whom you collaborate. (If you have questions about “property” vs. “consumables” please check with us.)

Please initial the box below to affirm that you understand and accept this condition.

4.  Worker’s Compensation

Students who participate in a community-based research project through MSU Denver are covered under MSU Denver’s Worker’s Compensation Program when on-site and completing their hours. In order to ensure that all students are protected, all students participating in the grant funded CBR project must have a signed Worker’s Compensation form on file.

A copy of the form can be found at http://www.msudenver.edu/media/content/humanresources/resources/workersCompensationPolicy.pdf.

5.  Final Report

CBR fellows will be expected to present their work at the Undergraduate Research Symposium and/or High Impact Summit at the end of Spring semester.

Please initial the box below to affirm that you understand and accept this condition.

If you have any questions about the community-based research fellows application, please contact Salina Blea, Undergraduate Research Coordinator, at

Thank you!