Type of Application (selectone only):
Research Capacity building Knowledge Translation, Advocacy and Policy
Principal Applicant Information:
Name: ______
Telephone Number: ______
Email address: ______
Position:
Primary Job Title: ______
Primary Division/Program: ______
Proportion Time Protected for Research: ______
For research proposals, does the Principal Applicant meet the definition of the “Principal Investigator” as outlined in SickKids’ “Research Grant Proposals: Eligibility, Review and Approval Policy”
Select one only YES NO
If ‘NO’, please complete the PI sponsor section below (must also be listed as a co-applicant below).
Principal Investigator Sponsor Information:
Name: ______
Telephone Number: ______
Email address: ______
Position:
Primary Job Title: ______
Primary Division/Program: ______
Proportion Time Protected for Research: ______
PI Sponsor agrees to be responsible for official communication with the Research Institute (including communication with the Research Ethics Board) and must provide mentorship and guidance to the principal applicant.
Print Name:______
Signature:______
Application Title: ______
Amount Requested (CAD):______
Co-Applicant(s) Information:
Name: ______Title: ______
Email: ______C-GCH staff member YES NO
Name: ______Title: ______
Email: ______C-GCH staff member YES NO
Name: ______Title: ______
Email: ______C-GCH staff member YES NO
Name: ______Title: ______
Email: ______C-GCH staff member YES NO
Checklist:
Application Form
Project Plan (5 pages, 12-point font) including 3-3.5 pages total for items a-e (see guidelines); 1.5 - 2 pages for f-i. Abridged protocols, questionnaires not to exceed three pages (web links acceptable) can be submitted in addition to a maximum of two relevant supporting articles if appropriate.
Curriculum Vitae (to be submitted as a separate file from (Research/Project). One CV per Principal Applicant. Maximum 5 pages
______
Principal Applicant’s Signature Date
I have read, understood and pledge to adhere to the 2016 SickKids C-GCH Catalyst Grant Competition Guidelines associated with submitting this application. Furthermore, I declare that this project/idea for which I am submitting this application is in no way, shape or form, already being funded or has any overlap with other grants.
______
Co-Applicant’s Signature Date
______
Co-Applicant’s Signature Date
______
Co-Applicant’s Signature Date
______
Co-Applicant’s Signature Date
______
Co-Applicant’s Signature Date
I have read, understood and pledge to adhere to the 2017 SickKids C-GCH Catalyst Grant Competition Guidelines associated with submitting this application. Furthermore, I declare that this project/idea for which I am submitting this application is in no way, shape or form, already being funded or has any overlap with other grants.
1
______2017 SickKids C-GCH Catalyst Grant Competition Application