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AGD Foundation Grant Proposal Application by xdb19855

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									Grant
Proposal Application




Academy of General Dentistry Foundation
211 E. Chicago Ave., Suite 900
Chicago, IL 60611-1999
Phone: (312) 440-4306 Fax: (312) 440-0559 E-mail: foundation@agd.org




AGD Foundation Grant Proposal Application



General Information:

The Academy of General Dentistry Foundation (AGDF) funds grants that
improve the oral health of the public and support the professional
development of the general dentists through continuing education, access to
care, and oral health literacy programs.
The Mission Statement of the Academy of General Dentistry Foundation:
The Academy of General Dentistry Foundation is dedicated to improving the
oral health of the public and supporting the efforts of the general dentist,
through financial support of scientific, educational and charitable
initiatives, which are delineated by the Academy of General Dentistry.

The Mission Statement of the Academy of General Dentistry:
The mission of the Academy of General Dentistry is to serve the needs and to
represent the interests of general dentists, to promote the oral health of the
public, and to foster continued proficiency of general dentists through
quality continuing dental education in order to better serve the public.
Case Statement of the Academy of General Dentistry Foundation
The AGD Foundation supports dental access programs that help make
dental care and oral health literacy available to underserved populations,
and educational programs that train the general dentist to better serve the
aged, physically and mentally challenged and children, particularly those
whose economic circumstances places them at risk, believing that better oral
health will lead to increased overall health and add to their quality of life.
Application Procedure:
The AGDF Board will consider proposals that:
1) Clearly define the project with a specific timeline and budget
2) Contain scientific, educational or charitable initiatives which meet the
goals of the AGD and AGDF
3) Contain measurable outcome criteria

Applicants should be involved in projects with clinical applications for the
general dentist.
The format of the actual application should be as follows:

8.5 x 11 inch paper in plain binders
1-inch margins with no less than single line spaces and a font no smaller
than 12 pts.
12 copies of the application and all additional materials
Cover Page:
Form provided by the AGDF
Title Page:
Single page
Description of Project:
Single page, including long-term goals and its relation to the goals of the
Academy
Budget Detail:
Direct costs only are fundable. The AGDF does not fund indirect costs. A
list of all project support sources should be included; identify the agency,
institution, foundation, or other organizations that are providing financial
support; justification for all project expenses should be included
Curriculum Vitae:
One for the program director and each investigator, not more than two pages
in length
Project Plan:
Include scientific, educational or charitable initiative to be achieved
Include experimental design and methods, if requesting a research grant
significant background information; measurable outcome criteria
Time Line
History of the organization seeking funds
Appendix:
Any information that supports the application including articles published by
the investigator, if requesting a research grant.

Please note the following:

- The AGDF will not provide critiques of the applications.
- Applications will be initially reviewed by the AGDF Grant Review
Committee. If criteria are met, the full Foundation Board of Directors will
review the application during its Winter and Summer meetings. The grant
proposal should be submitted by November 15, for review in Winter; by
April 15, for review at the Summer Board Meeting.

- Letters of support from General Dentistry faculty may be included in cases
where faculty are involved in the grant request only if the persons writing
are directly involved in the project

Applications must be sent to:

Academy of General Dentistry Foundation
211 East Chicago Avenue, Suite 900
Chicago, IL 60611-1999
Phone: (312) 440-4306 Fax: (312) 440-0559 E-mail: Foundation@agd.org
Progress reports must be submitted in writing to the Foundation every six
months for the duration of the award, including budget reports.
AGD Foundation Grant Proposal Cover Page

Name of Proposed Project:
________________________________________________

_____________________________________________________________
_________

2. Amount of funding request:

$_________________ in calendar year _______________


3. This project is circle: educational research access oral health literacy other
If other is circled please include the appropriate category in your project
plan.

4. What Goal(s) of the AGD and AGDF will this project seek to fill? (goals
are attached to this form).

_____________________________________________________________
_________

5. List funding request purpose.

_____________________________________________________________
_________

Project timeline:
________________________________________________________


Project Plan (not to exceed 4 pages) a description of the proposed project
must be included. Potential relevance to general practice dentistry and value
to the Academy of General Dentistry should be explained. Specifically
identify the gaps which the project is intended to fill. Include background
information on the project, and key personnel and their role in the project.
Please complete the following budget line items for review by the AGDF.
General Budget

Total Amount Requested from AGDF
$___________________________________

Funds From Other Sources $___________________________________

Total Project Cost $___________________________________

Budget Categories for AGDF Funds

Clinician Honoraria $___________________________________
Equipment and Supplies $___________________________________

Travel and Lodging $___________________________________

Other Expenses $___________________________________

The applicant agrees to submit a full report on how the funds are spent and
the progress in accomplishing the purposes of the grant, every six months for
the duration of the award, or no later than 60 days after the completion of the
granted project.

Name of
Applicant_____________________________________________________
________

Address_______________________________________________________
_______________

City _______________________ State/Province__________ Zip/Postal
Code ____________

Phone __________________ Fax____________________ E-
mail______________________

Signature of Applicant
_____________________________________________
Date of Submission
____________________________________________________________

The Academy of General Dentistry Foundation reviews funding proposals
twice a year at its Board Meetings, which are held in Winter and Summer.
Deadline for proposals to be reviewed at the Winter meeting is October 15.
Deadline for proposals to be reviewed at the Summer meeting is April 15.




AGD Foundation Goals

Goal A. To fund and support the development of quality continuing dental
education programs which develop and disseminate resource materials
that address the unmet educational needs of general dentists.

Goal B. To provide funding to support educational initiatives that improve
access to needed oral health care and eliminate health disparities.

Goal C. To fund and support research in continuing dental education and
applied clinical research that would facilitate the transfer of new knowledge
to the dental practitioner.

Goal D. To fund and support the development of new learning models for
dental professionals.

Goal E. To develop mechanisms to encourage annual Foundation
contributions from AGD members and others.


AGD Organizational Goals

Goal 1. To serve the needs of general dentists.

Goal 2. To represent the interests of general dentists.

Goal 3. To promote the oral health of the public.
Goal 4. To foster continued proficiency of general dentists through quality
continuing education and to promote and recognize the educational
achievements of AGD members throughout the profession.

Goal 5. To be structured and governed to facilitate timely, rational and
fiscally sound decision making and efficient utilization of resources.




10/13/04




Proposal Check List

Please be sure that the information listed below is included with the returned
proposal. Incomplete proposals will be returned to the sender and may delay
the review process.

____ Cover Page – this was included with the proposal request form. Be
sure to include the contact information for the person completing the
proposal.

____ Title Page.

____ Description of Project:
Single page, including long-term goals and the projects relation to the goals
of the AGD and AGDF.

____ Budget Detail:
Indirect costs are not eligible; a list of all project support sources should be
included; justification for all project expenses should be included.

____ Name of financial officer and their credentials.

____ Curriculum Vitae:
One for each investigator, not more than two pages in length. Include the
resume or job description of the person responsible for receiving and
processing expenditures related to this process.

____ Project Plan:
Include how you will measure the success of the proposal if funded.

____ Time Line:
Expanded from the Cover Page.

____ Brief history of the organization seeking funds.

____ Appendix:
Any information that supports the application including articles, and needs
assessments.

								
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