Proposal Application | Women's Sports Forum

PAM WHITEHEAD FORUM FUND

RESEARCH APPLICATION

Name

Institutional Affiliation

Date Submitted

Project Title

Project Dates

Project Total Costs

EXISTING RESEARCH SUPPORT (if applicable/needed for this proposal):

Existing Support Source A

Amount

Existing Support Source B

Amount

Existing Support Source C

Amount

Existing Support Source D

Amount

OTHER PENDING RESEARCH SUPPORT (if needed for this project):

Pending Support Source E

Award Date E

Amount E

Pending Support Source F

Award Date F

Amount F

Pending Support Source G

Award Date G

Amount G

Pending Support Source H

Award Date H

Amount H

How will the research plan be altered if the other pending support is not awarded?

REGULATORY ASSURANCES:

Please list any applicable regulatory approvals that will be required to carry out this proposal.

Committee A

Institution A

Approval Date A

Approval Number A

Exemption? A

Committee B

Committee C

Committee D

Institution B

Approval Date B

Approval Number B

Exemption? B

Institution C

Approval Date C

Approval Number C

Exemption? C

Institution D

Approval Date D

Approval Number D

Exemption? D

BUDGET (Maximum $5000)

For each section, please include an itemized list (including item and cost) along with a brief justification.

Please note that "investigator" salary and indirect costs CANNOT be supported by this funding mechanism.

EQUIPMENT

Equipment Item A

Number/Amount A

Cost Per Item A

Total A

Equipment Item B

Number/Amount B

Cost Per Item B

Total B

Equipment Item C

Number/Amount C

Cost Per Item C

Total C

Equipment Item D

Number/Amount D

Cost Per Item D

Total D

Equipment Item E

Number/Amount E

Cost Per Item E

Total E

Equipment Item F

Number/Amount F

Cost Per Item F

Total F

Equipment Item G

Number/Amount G

Cost Per Item G

Total G

Equipment Item H

Number/Amount H

Cost Per Item H

Total H

Equipment Total

SUPPLIES

Supplies Item A

Number/Amount A

Cost Per Item A

Total A

Supplies Item B

Number/Amount B

Cost Per Item B

Total B

Supplies Item C

Number/Amount C

Cost Per Item C

Total C

Supplies Item D

Number/Amount D

Cost Per Item D

Total D

Supplies Item E

Number/Amount E

Cost Per Item E

Total E

Supplies Item F

Number/Amount F

Cost Per Item F

Total F

Supplies Item G

Number/Amount G

Cost Per Item G

Total G

Supplies Item H

Number/Amount H

Cost Per Item H

Total H

Supplies Total

OTHER (Including Personnel)

Other Item A

Number/Amount A

Cost Per Item A

Total A

Other Item B

Number/Amount B

Cost Per Item B

Total B

Other Item C

Number/Amount C

Cost Per Item C

Total C

Other Item D

Number/Amount D

Cost Per Item D

Total D

Other Item E

Number/Amount E

Cost Per Item E

Total E

Other Item F

Number/Amount F

Cost Per Item F

Total F

Other Item G

Number/Amount G

Cost Per Item G

Total G

Other Item H

Number/Amount H

Cost Per Item H

Total H

Other Total

Overall Budget Total

RESEARCH PLAN

LAYPERSON SUMMARY

PROJECT OBJECTIVES (AIMS)

BACKGROUND

CLINICAL RELEVANCE

METHODS AND PROCEDURES

POWER ANALYSIS AND STATISTICAL ANALYSIS

FEASIBILTY

REFERENCES:

This should not be an exhaustive review, but rather key publications that will help the committee understand the basis for, importance of, and feasibility of your proposed research.

Reference A

Reference B

Reference C

Reference D

Reference E

Reference F

ATTACH YOUR CURRICULUM VITAE:
(2-3 page biosketch is sufficient)

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EXISTING RESEARCH SUPPORT (if applicable/needed for this proposal):

OTHER PENDING RESEARCH SUPPORT (if needed for this project):

BUDGET (Maximum $5000)

RESEARCH PLAN

REFERENCES: This should not be an exhaustive review, but rather key publications that will help the committee understand the basis for, importance of, and feasibility of your proposed research.

ATTACH YOUR CURRICULUM VITAE: (2-3 page biosketch is sufficient)

REFERENCES:

This should not be an exhaustive review, but rather key publications that will help the committee understand the basis for, importance of, and feasibility of your proposed research.

ATTACH YOUR CURRICULUM VITAE:
(2-3 page biosketch is sufficient)