Faculty Research Grant Program

Faculty Research Grant Program

The University of Tulsa

Revised 1/13/2015

Research Application

PERSONAL DATA

Name: / Ext.
Discipline: / Academic Rank:
Date of Submission:
TITLE OF PROPOSED RESEARCH:
AMOUNT OF SUPPORT REQUESTED: $
ARE HUMAN SUBJECTS INVOLVED IN THIS RESEARCH? YES NO
If yes, a copy of the approval letter from the IRB must be attached. If you have not already received approval, you must also submit the “Application for Research Involving Human Subjects”, an informed consent, and any surveys, interview protocols, etc. with this application.
ARE CHEMICALS INVOLVED IN THIS RESEARCH? YES NO
If yes, the department chairperson must initial the following line as verification that the applicant has attended a Hazardous Material Training Session and/or laboratory safety session. The department has a list of departmental faculty, staff, and students who have attended a safety seminar.
Department Chairperson / Date Attended
ARE ANIMALS INVOLVED IN THIS RESEARCH? YES NO
If yes, a copy of the approval letter from the Institutional Animal Care and Use Committee must be attached. If you have not already received approval, you must submit the protocol with this application.
INSTITUTIONAL BIOSAFETY REVIEW:
If your research involves the use of infectious agents, select agents and toxins, human or endothermic vertebrate materials (including blood, body fluids, cells and tissues), recombinant DNA, synthetic nucleic acid molecules or transgenic animals, the protocol may require Institutional Biosafety Committee (IBC) review and approval. Please contact Dr. Estelle Levetin (x2764) if your research involves any of these items. If IBC approval is necessary, a protocol must be submitted with this application.
As Department Chair, please sign below to confirm that you have reviewed this grant application for Biosafety compliance and have determined that:
YES this grant application has been forwarded to the IBC Chair for further review, or
NO this grant application does not need to be forwarded to the IBC Chair for review
Department Chairperson______Date:______
IBC Chairperson approval______Date:______
(if applicable and the “YES” box is marked above)
DESCRIPTION OF PROPOSED RESEARCH
Please attach a concise narrative statement providing details of the proposed research following the outline presented below. This information is essential.
A. Title.
A. B. Summary of objectives and significance of the project. (Indicate whether this is a new project or one which is currently underway.)
B. C. Procedure to be followed, including experimental details if necessary.
C. D. Estimate of time required to complete the project and desired starting date.
D. E. Previous work done in the field. (Include a list of your relevant publications).
E. F. Internal support. Explain briefly efforts made to obtain requested budgeted items for this research from University sources, such as department and college.
F. G. Outside support. (1) Describe prior efforts made to seek outside funds for proposed research with results obtained, and (2) include information regarding potential sources that could be contacted for funds after completion of research.
G. H. Previous internally funded grants or fellowships from the past three years. Give title and program of the award, describe significant results from each award, list papers, publications, presentation, or sponsored projects that were an outgrowth from this research.
Please complete the Budget Form below.
ESTIMATED BUDGET /

AMOUNT

  1. TRAVEL FOR RESEARCH: Destination and mode of travel (car, plane, etc.)

$
  1. OTHER PERSONNEL (describe)

$
  1. SUPPLIES AND MATERIALS (describe)

$
  1. SPECIALIZED RESEARCH EQUIPMENT (describe)

$
  1. COMMUNICATIONS

$
  1. SERVICES

a. Duplication and reproduction / $
b. Other / $
BUDGET ITEMS NOT ITEMIZED
$
$
$
TOTAL BUDGET REQUEST / $
APPROVAL SIGNATURES
Department Chairperson / Date
Collegiate Dean / Date
ACTION TAKEN BY EVALUATION COMMITTEE:
DECLINED / APPROVED / AMOUNT GRANTED $