Sara Elizabeth O’Brien Trust Award
Bank of America, N.A., US Trust, Trustee
Application Face Sheet
2018 Grant Cycle
Project Period 9/1/18-8/31/19
Contact: Jeanne Brown, Program Officer, The Medical Foundation, at HRiA, , 618-279-2240 x709
TITLE OF PROJECT / KEY WORDSAPPLICANT
Name and Degree:
Title:
Department:
Institution or
Organization:
Table of Contents
Application Face Sheet...... 1
Table of Contents...... 2
Research Project Summary and Performance Sites...... 3
Research Proposal......
Specific Aims......
Background and Significance......
Potential Impact......
Research Design and Methods......
Projected Timeline......
Collaboration description (if applicable)......
Bibliography ......
Biographical Sketch of Applicant......
Biographical Sketch(es) of Key personnel (if applicable) ......
Budget Forms A-C ......
Letters of Support/Collaboration/Recommendation......
Appendix (if applicable)......
Research Project Summary and Performance Sites
State the project’s broad, long-term objectives and specific aims. Describe concisely the research design and methods for achieving these goals. This abstract is meant to serve as a succinct and accurate description of the proposed work and will be posted on our website if the project is funded. (300 word maximum)
Key Words:Project Summary
Performance Site(s)(institution, city, state):
FORM A
PROJECT BUGDET
Expense Categories / Role / % of Effort / Salary / Fringe / Fringe Rate = % / Total / Other Funding / Noonan RequestPERSONNEL (Name)
EQUIPMENT
SUPPLIES
CONTRACTUAL
OTHER (Specify)
Total Direct Costs
Total Indirect Costs
Total Cost for 12 month Project
Form B
JUSTIFICATION OF PROJECT EXPENSES
(Requested from Noonan Fund)
Personnel:
Equipment:
Supplies:
Other:
Form C
CURRENT AND PENDING SUPPORT
(Copy and Paste for Each Funding Source)
Applicant Name:Title of Project:
Principal Investigator:
Role and % Effort of Noonan Applicant:
Funding Source and Type of Grant:
Funding Start and End Dates:
Total Costs:
Annual Direct Costs:
Amount and % of Noonan Applicant’s salary included in the grant:
Funding Status: / Current / Pending
Related to the Noonan Proposal? / Yes / No
Describe any scientific or budgetary overlap with the proposed Noonan Fund research project and outline a plan to avoid duplication of funding (use extra space as needed):