Research Award Application

Please fill out a Research Award Application using the form below.

Today's Date

Applicant Information

First Name

Last Name

Email

Phone Number

Year in Medical School

Mentor Information

Mentor's First Name

Mentor's Last Name

Mentor's Email

Mentor's Phone Number

Specialty, department or field

Academic Rank

Research Project Description

Amount of Funding Requested (maximum $5,000)

Type of Project - Select the category that best describes your project.

Project Title - Max 150 characters.

Research Project Summary - Describe briefly: 1) your objectives or hypothesis, 2) a brief description of your plan, 3) and its relevance to the field. (max: 4500 characters)

Project Timeline - Develop a timeline including projected completion of preparations (including animal and human subjects protocol approvals); preliminary studies; data collection and analysis; writeup. (max: 4500 characters)

How does this benefit the Sanford School of Medicine?

Budget Justification: Describe the types of expenses that will be covered by the award. The total estimated expenses combined for all expense categories should equal the total amount requested.

Research Reagents Estimated Expense (e.g., enzymes, antibodies, kits)

Research Reagents Description of Items Needed - Provide specific details.

Consumables Estimated Expense (e.g., pipets and tips, flasks, plates)

Consumables Description of Items Needed - Provide specific details.

Outsourcing Estimated Expense (e.g., sequencing, antibody production, or any work that you are paying someone to perform)

Outsourcing Description of Items Needed - Provide specific details.

Other Estimated Expenses (i.e., any expenses not included in the categories above)

Other Description of Items Needed - Provide specific details.

Total

Human Subjects and Animal Protections

Human Subjects - Does your project involve human subjects, data from human subjects, and/ or specimens from human subjects? Yes No

Animal Protections - Does your project involve the use of vertebrate animals for research? Yes No

Does your project require IRB Approval Yes No

If Yes, Has Your Project Been Given IRB Approval Yes No Pending

If Applicable, Provide PI's IRB Number

If Applicable, Provide IRB Date

If Applicable, Provide PI's IACUC Number

If Applicable, Provide IACUC Date

Confirmation and Agreement

Confirmation - Yes, I Confirm

By checking this box, I confirm that I have discussed this project proposal with my mentor(s) and have their support for carrying out the research plan.

Agreement - Yes, I agree

Funding awards have reporting and programmatic requirements. These requirements include submitting a final project report and a poster presentation (or talk) of your research. Also, awardees must acknowledge the support of the US

Research Award Application

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