Global Mental Health Seed Grant

Global Mental Health Seed Grant

Seed grant application FORM

Please refer to the Seed Grant Application Instructions before completing this form. Note that your response to the Project Description, Section B, is limited to a total of seven (7) pages. Sections A, C-I will not be included in this seven-page limit.

Completed Letters of Intent must be electronically submitted to Grand Challenges Canada via email to by February 4, 2013, at 11:59 p.m. ET.

A.  Contact Information

Legal name of applicant organization:

Country of applicant organization:

Project title:

Name of Principal Investigator(s)

/

Organization of Primary Affiliation

/

Contact Information

Name of organization:
Country of organization: / Email:
Telephone:
Address:

Name of Collaborator(s)

/

Organization of Primary Affiliation

/

Contact Information

Name of organization:
Country of organization: / Email:
Telephone:
Address:

Name of primary contact:

Contact information for primary contact (if not listed above):

B.  Project Description

I) Project Impact and Background

2

Impact:
Outcome(s):
Objectives / Activities / Critical milestones / Metrics of success / Estimated dates / Estimated Cost (CAD)
Objective 1:
The major components of the project required to achieve the project’s anticipated impact. / Activity 1.1:
Activity required to reach this objective. / Quantitative or qualitative outputs that will demonstrate achievement of this project activity. Each activity should have at least one critical milestone/metric of success. / Estimated start and finish dates for the activity, e.g., Month 1–6 / Indicate the total cost of completing this activity
Activity 1.2:
Activity 1.N:
Objective 2: / Activity 2.1:
Activity 2.2:
Activity 2.N:
Objective N: / Activity N.1:
Activity N.N:
TOTAL BUDGET (CAD)

II) Project Framework

Outline any additional financial support that has been leveraged (cash or in-kind):

2

III) Overview of Approach

IV) Major Assumptions, Key Risks and Mitigation Strategies

V) Investigator Capability

IV) Organizational Capacity

C.  Description of Other Grand Challenges Canada Funding

D.  Citations

E.  Biographical Information

F.  Letters of Support

G.  Letters of Recommendation

H.  Certification

By submitting this proposal, you certify to Grand Challenges Canada that you are authorized to apply for this project on behalf of your organization.

I.  Budget Spreadsheet and Budget Notes

·  Personnel and Fringe Benefits (Direct FTE Costs) – For each person listed on the budget, provide:

o  Name

o  Project role (description)

o  Brief summary of duties and responsibilities

o  Components of fringe benefits package (i.e., health and dental insurance, pension contributions, etc.)

·  Travel (Direct Travel Costs)

o  Number and type of trips

o  Total cost of trips

o  Descriptions of how travel benefits the project

o  Descriptions on why the travel is necessary

o  Other justification of travel expenses

·  Consultants (Direct Consulting)

o  Nature of consultant work

o  Why consulting work is necessary for the project

o  Unique skills or expertise of consultants chosen

o  Consulting selection process

o  Description of consultant cost components

·  Direct Supplies and Services (Direct Supplies)

o  Brief description of the requested supplies, services or other costs (e.g., maintenance contracts, publication costs)

o  Explanation of how the items will be used to accomplish the work on the project

·  Equipment (Direct Equipment)

o  Brief description for each item of equipment requested

o  Explanation of how each item will be used

o  Explanation of why the purchase of the equipment is necessary

·  Other research costs

o  Brief description of other direct research costs not applicable to the previous categories

o  Explanation of why these costs are necessary

·  Indirect project costs

o  Brief description of administrative costs associated with the project but not directly related to the research – Grand Challenges Canada will fund indirect costs equal to a maximum of 13% of the total project cost, including indirect costs for sub-grantees

·  Sub-grants and subcontracts (Sub-awards Total)

o  Attributes and expertise of each organization chosen to participate on this project as a sub-grantee or subcontractor

o  How their participation will benefit the project

·  Other Sources of Support for This Project (if applicable)

o  Name of each additional donor

o  Amount from each donor

o  Is funding committed or potential?

o  Will the receipt of these additional funds affect the ability of the research team to complete the objectives of this proposal (i.e., if these additional funds are not received, is the project still feasible?)

o  Other relevant details, including overlap with Grand Challenges Canada funding, contingency plans if funds are not made available, timing of funding

·  Other Related Funded Projects

o  List of other funded projects performed either by the primary grantee or sub-grantees/contractors that are significantly related to this project

o  Description of possible opportunities for synergy or coordination.

2