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: firstname.lastname@example.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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