Research Council Meeting

NURSING RESEARCH FELLOWSHIP APPLICATION - 2015 Loyola University Health System

Complete the application form below and e-mail or send the completed form to: Pam Clementi, Nurse Manager, Nursing Education Department, LUMC, Mulcahy, Room 0701; Fax #64759; or [email protected]

DUE DATE: Friday November 14, 2014 by 1700

Name and Credentials of Applicant Please attach current resume

Contact Phone # E-Mail address

1. What are you interested in studying? What patient care question are you interested in researching?

2. Why is this topic important to your practice area?

3. What population do you wish to study?

4. What possible team members are you considering to invite to help you complete this project?

5. Are you aware of a clinical expert (nursing or other discipline) in your area of study at Loyola? If so, please identify the expert.

6. How do you plan to make the commitment to complete the project within the 18 month period?

D:\Docs\2017-12-28\07bfe752aff052b5c6f53d4a3344dd0d.doc 7. Besides learning the research process, what other support do you identify as needing? Check all that apply.

_____ Computer access _____ Literature review process _____ Computer software assistance _____ Writing Abstracts ______Excel _____ Presentation Skill ______Power Point ______Statistical Support Programs like SPSS ______Statistics ______Transcription _____Other ______

8. What strengths do you bring to the project?

Applicant Statement I understand that being selected for this project involves working on a research project including writing a proposal, submitting an application to the IRB, implementing and collecting data, data evaluation and presentation of results. I understand this is an 18 month commitment that includes attendance at scheduled classes, monthly work meetings, Nursing Research & EBP Council Meetings, as well as, completion of assignment by the identified dates.

______/ ______/ ______Signature of Applicant Print Name Date

Manager/Supervisor Signature and Statement of Support This employee fulfills all requirements of their position, as well as, maintains the policies and work rules of their position (i.e. no work improvement plan or discipline in process). I understand that if this employee is accepted into the Nursing Research Fellowship it will mean release time of 96 hours over the next 18 months. Please indicate your level of support for the applicant:

______/______/______Signature of Manager/Supervisor Print Name Date

D:\Docs\2017-12-28\07bfe752aff052b5c6f53d4a3344dd0d.doc