The Baby Alex Foundation
Grant Application
Deadline: First Friday in March
Please provide all the information requested below regarding your proposed research project. Applications missing information will not be considered for a grant. If you have questions about the application, please contact Nicole Schmidt at . Please send one (1) electronic copy of this grant application and project narrative to Nicky at the above email. Thank you.
Please note that the Foundation does not allow the use of its grants to cover any indirect costs associated with your research. Additionally, as of the 2012 grant cycle, we will allow your institution to calculate a maximum of 10% of total researcher salaries to cover fringe benefits.
Application Date:
Applicant Contact Information
Primary Applicant
Name:
Organization:
Title:
Address:
Phone:
Email:
Fax:
Co-Applicant
Name:
Organization:
Title:
Address:
Phone:
Email:
Fax:
Co-Applicant
Name:
Organization:
Title:
Address:
Phone:
Email:
Fax:
Co-Applicant
Name:
Organization:
Title:
Address:
Phone:
Email:
Fax:
Project Information
Name of Organization Request Grant:
Proposed Project Title:
Total Funding Requested (between $5000 and $30,000):
Proposed Project Start Date (use format: mm/dd/yy):
Proposed Project End Date (use format: mm/dd/yy):
Proposed Project Duration (in months):
Indicate Type of Project:
○ Injury Prevention
○ Intra-Injury Research
○ Post-Injury Treatment
○ Education
Indicate the Primary Focus of Study:
○ Drug Research
○ Prevention of Premature Birth
○ Post-Injury Prognostic Indicators
○ Brain Wave Monitoring
○ Imaging
○ Post-Injury Physical Interventions
○ Post-Injury Cognitive Interventions
○ Family Education/Outreach
○ Medical Staff Education
Indicate Type of Study or Analysis Proposed:
○ Secondary Data Analysis
○ Replication
○ Planned Experimental Study
○ IRB Approval Required
○ Natural/Observational Study
○ Small-Scale Pilot Study or Lab Simulation
IRB
Does this project require an IRB? If so, please include with the application. Any study that requires an IRB but does not have one included in the application will not be considered for funding.
Please note that all grantees will be expected to document spending. Reporting requirements include a summary of findings due to the foundation 90 days from the termination of the project and a formal paper of publishing potential within one year from the termination of the project.
Signature of Primary Applicant: )______
Date: ______
Project Narrative
Instructions:
Please use the below guidelines to prepare a project narrative. Please type your narrative, using 12 point font, on separate paper. Please title your narrative according to the titles and in the order of those titles described below. Please do not exceed 10 pages, 1.5 line spacing, for your narrative. Graphs and tables are optional and may be in addition to the 10 page narrative limit. Please title the top of each pages as follows:
Project Title:
Principal Investigator:
Applicant Organization:
Rationale for Funding
Describe why the proposed project needs to be funded, conducted and completed on a time-sensitive basis. Please explain in detail how this project contributes to existing medical research. Describe the impact the research might bear on the medical field, patients and families.
Related Research
Provide a summary of research already completed on the topic or closely related topic of your study. Please include the author(s) and the journal title, volume, number and date of publication.
Project Aims
Outline the specific aims of your proposed project. State the significance of potential findings for improving the health of those individuals who fall within your proposal category (drug research, physical or cognitive therapy, etc).
Study Setting
Describe the study’s target population and the setting(s) in which your proposal study will take place. Please explain why you chose this target population and setting.
Research Strategy
Describe each of the following areas:
1) Study design (e.g., experimental, controlled study, etc);
2) Research methods and measures used, including the primary and secondary measures, the proposed data sources, and;
3) Brief overview of data analysis planned and measurables used for project success.
Names and Qualifications of Principal Investigator and Key Project Staff
Please describe the research qualifications, related past research and experience working with the proposed target population.
Names and Qualifications of Statistical Staff
These individuals should be responsible for calculating any statistics related to the project outcomes.
Partner Organizations and Co-Funding (only if applicable)
Prior Funding Sources and Amounts (if ongoing study)
Dates of Research (if ongoing study)
Estimated Timeline to Complete Proposed Project (Please Note: Projects spanning more than one year will be considered for yearly grant renewals upon submission of an updated application, which must include clearly defined outcomes from the previous
year’s research as well as a completed financial audit of funds. Renewal will be based on Grant Review Committee approval and available funding.)
Please describe the estimated timeline for completion of major project milestones.
Budget
Please provide a budget to indicate how grant funds will be used. Please note that Baby Alex Foundation grants are not to be used for the sole purpose of purchasing material goods (supplies), travel or other non-research related expenses. You may submit the budget in an Excel spreadsheet if necessary.
Name and address of Grant Manager
This individual will be responsible for the grant funds. Please indicate how the grant check should be addressed.
Web Site Description
Please include a brief description of your project that may be used on the web site should your project be awarded a grant.
Mailing Address:
Nicole Schmidt
The Baby Alex Foundation
P.O. Box 2224
Milford, CT 06460
Email Address: