Office of the Vice President for Research

University of Michigan

Robert Wood Johnson Health & Society Scholars Program

SMALL GRANT PROGRAM APPLICATION FORM

Application deadline is Wednesday, September 21, 2011 at 5:00 pm

Submit to: Meredith McGehee, Program Coordinator

Robert Wood Johnson Health & Society Scholars Program

Submissions should be in the form of a single PDF document that includes the following:

• Application form

• Proposal narrative

• NIH PHS 398 detailed budget page (Also submit as a separate Word document.)

• Budget justification (Also submit as a separate Word document.)

• NIH biosketch(es) for all key personnel

Is this proposal a resubmission? Yes No

PRINCIPAL INVESTIGATOR:

ACADEMIC RANK: E-MAIL:

DEPARTMENT/UNIT:

CAMPUS ADDRESS:

CAMPUS PHONE: DEPT ID REQUIRED (6 digits):

DEPT ADMIN NAME: DEPT ADMIN EMAIL:

COLLABORATORS:

Name Department

Name Department

AMOUNT REQUESTED: TODAY’S DATE:

DOES THE PROPOSED ACTIVITY INVOLVE HUMAN SUBJECTS: Yes No

If yes, IRB approval # approval date:

NOTE: A copy of the IRB Approval will be required for funded projects.

BUDGET SUMMARY & BUDGET JUSTIFICATION:

Please attach a PHS 398 NIH detailed budget page. A budget justification should be attached to this form which fully explains the relationship of costs to the proposed activity and the basis for cost estimates. In addition, if salary support is requested, provide detail including name, nature and percent of appointment, period of time, amount, etc.

PROPOSAL NARRATIVE: (MAXIMUM FIVE (5), single spaced, standard margin, size 12 font pages excluding citations.)

Your narrative should provide a concise description of the research, scholarship or creative activity, including:

a. Statement of nature, objectives, and expected outcome of proposed research/creative activity;

b. Description of the significance of proposed research/creative activity: in the discipline or field, for the applicant’s scholarship, and for the University;

c. Plans for accomplishing objectives; and

d. Sufficient information and details on methods and analytic techniques to permit an evaluation.