Road Safety Research Partnership Program

MINISTRY OF TRANSPORTATION

ROAD SAFETY RESEARCH PARTNERSHIP PROGRAM

Application Form

For Ministry use only:

Application Number: ______

Date of Submission: ______

Name of PrincipalInvestigator: / Name and title of Project Contact:
Phone Number:
E-mail:
Name of Sponsoring Institution: / Address of Sponsoring Institution:
;
Co-Applicants(Name, Institutional Affiliation, City):
1.
2.
3.
NewApplication: □ Re-submission:□
If a re-submission, provide previous application number:
Title of Research Project:
Purpose of Project:
Project Description:
Project Dates (start date, estimated end date):
TotalCostofProject: / FundsAwardedtoDate: / Current Request:
OtherFunding
Haveyouappliedtoanyotherfundingagencyforsupportforthisproject?
YES□ NO□
IfYES,pleaseattacha copy of the application for funding or notification of successful funding.
Signatures It is understood that the general conditions governing the Ontario Ministry of TransportationRoad Safety Research Partnership Program as outlined in the current Guidelines are hereby accepted and agreed to.
PrincipalInvestigator
Title: / HeadofDepartment
Title: / Dean/Director of Research or AuthorizedSigning Officer of Sponsoring Institution
Title:

MINISTRY OF TRANSPORTATION

ROAD SAFETY RESEARCH PARTNERSHIP PROGRAM

Summary Budget

Name of PrincipalInvestigator:
TitleofResearchProject:
PROJECTITEMS / FundsRequested
fromMTO under RSRPP / Amountfrom
OtherSources including In-Kind Funding / TotalBudget
SALARIESANDBENEFITS / XXXXNILXXXX
PrincipalInvestigator
OtherResearchScientists
(Post-doctoral,other)
ResearchAssistants
TechnicalStaff
Clerical,Secretarial,& AdministrativeStaff
SUBTOTAL:
EQUIPMENTSUPPLIES
Hardware
Software
Consumables(including maintenancecontractcosts)
SUBTOTAL:
OTHERCOSTS
ComputingCosts
DirectAdministrativeCosts
TravelAccommodation
Overhead(explainhow obtained)-maximumof15% oftotalbudget
Other(explain)
SUBTOTAL:
GRANDTOTAL:

MINISTRY OF TRANSPORTATION

ROAD SAFETY RESEARCH PARTNERSHIP PROGRAM

Summary Research Proposal

Name of PrincipalInvestigator:
Title of Research Project:
SUMMARY OF RESEARCH PROJECT
(Non-technical language; 300 words maximum)

MINISTRY OF TRANSPORTATION

ROAD SAFETY RESEARCH PARTNERSHIP PROGRAM

Sample Ethics Certification

Name of PrincipalInvestigator:
TitleofResearchProject:
CERTIFICATE OFETHICALACCEPTABILITYFORRESEARCH INVOLVING HUMANSUBJECTS
Themembersofthelocalethicalreviewcommittee,havingexaminedtheapplicationforfundingoftheabove-named project,considertheproceduresoutlinedbytheapplicantintheproposaltobeacceptableonethicalgroundsforresearch involvinghumansubjects.
MEMBERSOFTHEETHICALREVIEWCOMMITTEE
NAME
: / TITLE(academicposition) / FIELDOFEXPERTISE
Date / HeadofEthicsCommitteeorAuthorizedSigningOfficer