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SIGMA THETA TAU INTERNATIONAL HONOR SOCIETY ALPHA LAMBDA CHAPTER CHICAGO, ILLINOIS APPLICATION FORM FOR RESEARCH FUNDS Title of Proposal: Applicant’s Name: Address (street, city, state, zip code): Phone Numbers Home: Work: Fax: Email Address: Chapter of STT membership: Applicant’s Professional Status Master’s Student Doctoral Student (Please bold your reply) Post-Doc Fellow Practitioner Faculty Name of University / Institution: Amount Requested Anticipated Project Start Date Anticipated Project Completion Date Have you previously received a Sigma Theta Tau Research Award? Yes No (Please bold your reply) Date: Have you applied to another source for support of this proposed No Yes research? (Please bold your reply) If yes, please identify the funding agency, dollar amounts, start & end dates, and outcome of the submission (funded / not funded / pending / completed). in the space(s) below. Agency $ Requested $ Received Dates Outcome * * Please notify the Research & Awards Committee, if Pending Awards are received following this submission / issuance of award. How do the above proposals differ from or complement this application? Signatures Date Applicant Advisor / Chair / Mentor (Required only if applicant is a student or post-doc fellow) Submit the signed title pages to Susan Littau: room 608 College of Nursing. Submit the entire application electronically, including appendices, via email to firstname.lastname@example.org SIGMA THETA TAU INTERNATIONAL HONOR SOCIETY ALPHA LAMBDA CHAPTER CHICAGO, ILLINOIS RESEARCH GRANT AGREEMENT If the Research and Awards Committee approve my proposal, I agree: 1. To use the grant for the research project as described in the application and return any unused funds to the Treasurer of Alpha Lambda Chapter if the research is not finished by the projected completion date. Under certain circumstances, extensions may be obtained from Research and Awards Committee. 2. To acknowledge the financial support from Alpha Lambda Chapter, Sigma Theta Tau, Inc. in presentations and publications from the completed research project. Please use the following phrase: This project [or presentation, publication, etc] was supported by the Alpha Lambda Chapter, Sigma Theta Tau, Inc. 3. To give a Powerpoint presentation of the research findings at one of three Alpha Lambda Chapter, Sigma Theta Tau International, Inc. events: The Fall Scholars Program (usually in October), the Spring Scholars event (usually in February) or UIC’s Nursing Research Day (usually in March). A Powerpoint template will be provided. The presentation file must be submitted to the Research & Awards Committee Chair prior to the event. Date _______________ Signed ___________________________________________ (Applicant) Submit this page to Susan Littau: room 608, UIC College of Nursing. Modified 11/03/10 NOTE: Sections A through D are limited to 5 pages. A. Specific Aims: B. Background: C. Significance: D. Methods: E. Human Subjects / Animals: References: Budget: Please complete the table below. Be sure to list all costs of this study, then indicate the amount requested from Sigma Theta Tau (cap is $2500). Items Cost per No. Total Cost Comments/Justification item required § $ TOTAL for Research Study TOTAL requested from Sigma Theta Tau $ Biosketches: Please list below and insert here. Use the NIH format, found at http://grants.nih.gov/grants/funding/phs398/phs398.html Appendices: Please list below and attach as a single document. Please limit appendices to study instruments and any other information critical to evaluating the proposal (letters of support etc). Do NOT use the appendices section to circumvent the page limitations. Please be aware that the reviewers are not obligated to read all pages of the Appendices.
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