Lilly Oncology Advancing Patient Care Project
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Oncology Nursing Society
Lilly Oncology ‘Advancing Patient Care’ Project
APPLICATION FORM
IMPORTANT: Applicant is required to be an ONS member and a registered nurse (RN), plus have a minimum of one year’s experience in oncology nursing. Applicant should focus her or his primary duties and responsibilities on full-time patient care and demonstrate a commitment to the ONS Core Values. This application must be completed by the applicant and contain first and last name, ONS Member ID #, and complete contact information including email address.
(Note: only email submissions of this form and/or your supporting documentation can be accepted – no faxes or hard-copies permitted. If submitting separate documents, please be sure to include your last name within the document title for each document submitted. After completing all required items on this application, submit electronically to ONS Awards, [email protected].)
Before completing the application, the applicant agrees that she/he has read the following Funding Accountability and Reporting Expectations, Application Materials, Scoring Criteria, and understands what is required:
Funding Accountability and Reporting Expectations Award funds may not be designated to a third party, donated as a charitable contribution to another entity, or used for professional membership dues. Funding for college tuition, certification or credentialing is not eligible. Additionally, funds will not be granted for conference registration fees, travel expenses, hourly wages or salary, corporate overhead expenses, or capital equipment purchases. Funds can only be used for new projects and cannot be used to pay for, or reimburse for, previous completed projects or for projects already in progress.
Funds must be utilized within the timeframe identified for the project. Upon completion of the project, all unused funds must be returned to ONS within 60 days of the project’s completion. If a project is not completed due to unforeseen circumstances, all unused funds must be returned to ONS immediately.
If funded, the recipient will be required to submit a report at the conclusion of the project which evaluates project success, demonstrates outcomes achieved, and accounts for expenses. The report must be submitted within one month of project completion to the ONS Director of Membership and Component Relations. Any unused funds must be returned to ONS within 60 days of the project’s completion.
Application Materials When completing this form, applicants should provide as much detail as possible, along with any supporting documentation (if applicable). Please see the full application for complete instructions. Remember to allow 60 days from the date of your application for funding notification, should your project application be accepted. All applicants, whether approved or not, will be notified the following month after submitting the application.
Scoring Criteria Funds will be awarded to qualifying applicants whose project demonstrates merit as a/an: Professional development or continuing nursing education activity that relates to oncology nursing leadership Training activity that teaches oncology nursing leadership and/or quality patient care topics to other nurses ONS chapter or ONS Community (SIG)-sponsored educational program that provides learning opportunities addressing the topics of oncology nursing leadership and/or improving patient care. Please provide us with complete details of your proposed project by answering the following questions. You may include your answers on this application form, or submit a separate document, and if you do use a separate document, be sure to include each of the following questions along with your answers.
If you have additional supporting documents for any or all of the questions, you may attach those as a separate document. If you have additional supporting documentation, we recommend you scan and save all documents into one document (PDF format preferred, but not required). Be sure to use your last name in the supporting documents’ title.
IMPORTANT INFORMATION REGARDING PROPOSED BUDGETS & JUSTIFICATION: Many Lilly Project applications are rejected because of the lack of financial details in the proposed budget. Please be sure to explain, in detail, each line item of your proposed budget and remember to consider the funding limitations as stated on the first page of this application when submitting your proposed budget. Tell us how you arrived at each budget figure, complete with a break-down of proposed costs and expenses. For example, if your project includes a luncheon for the attendees, tell us how many attendees you expect, the cost of the meeting room rental, what are the food and beverages cost per person (plus tax and gratuity), audio/visual rental costs, and other related information to the project’s costs. The more comprehensive details you provide, the better your chances are of being approved.
APPLICATION (all of the following items are required – if left blank or incomplete, your application could be denied)
Applicant’s full name:
ONS Member Number:
Preferred email address:
Preferred mailing address:
Title of your proposed project:
Funding amount requested (maximum: $5,000.00):
Category/categories relevant to project (check all that apply): __ Professional Development __ Clinical Practice/Patient Care __ Other (please specify):
IMPORTANT: If you are applying on behalf of your ONS Chapter or ONS Community (formerly called Special Interest Group, or SIG), you will need to provide us with a statement that your ONS Chapter or ONS Community has authorized you to apply on their behalf and the project is, indeed, a Chapter (or Community) project. If your project isn’t for your Chapter or ONS Community, please skip this portion and apply as an individual ONS member:
__ Yes, I am applying on behalf of my ONS Chapter Name of your ONS Chapter: Your Chapter board position/title:
__ Yes, I am applying on behalf of my ONS Community (formerly SIG): Name of your Community/SIG: Your Community/SIG position title:
__ No, I am applying as an individual ONS member
For the following items, please provide us with as many details as possible. You may type in the space below each item, or provide us with a separate document that addresses each item. Applications missing any of these items will not be considered. Be sure to save a completed copy of your document for your records before submitting to ONS Awards ([email protected]).
Purpose of Your Project/Overall Goals: (Provide an overall general descriptive statement about your project)
Project Objectives: (What are some of the specific things you want to accomplish or gain from successfully completing this project)
Project Assessment: (Tell us why the project concept was developed, who is going to benefit from the project, and provide any other additional determining factors related to this activity)
Project Proposal: (In the space provided or on a separate document, provide a comprehensive description of your project. Please include as much detail as possible, to include names of participating individuals, organizations, local ONS chapter or ONS Community (formerly SIG) if applicable, professional development program information, etc. Also include what is to be accomplished at each step of the process and what the final outcome should be when the project is completed, such as CNEs, certificate of completion, etc.)
Time Frame: (Show all phases of your project time-line and what is to be accomplished at each step of the time-line. Please include specific dates for each step) Budgets & Justification: (Estimate all project costs, item by item, and provide justification and complete details for each line item, i.e. cost of educational program registration fees, securing venue, include security deposit if required, equipment rental such as audio/visual, supplies, travel/meal costs, if applicable.)
Evaluation Plan/Outcomes: (Show outcomes in relation to goals set)
Will your project proceed if not funded? __ Yes __ No
Will your project proceed if partially funded? __ Yes __ No
Has previous funding been applied, awarded, or anticipated for this or a similar project? __ Yes __ No If ‘Yes’ please list the name(s) of the organization(s) and the amount applied for:
Please note: If your application is approved for funding, the recipient will be required to submit an IRS W9 form (ONS will email a blank W9 form to approved applicants). Additionally, if your application is approved you will be required to submit a summary report at the conclusion of the project that demonstrates the outcomes achieved and evaluating the success of the project, which must include an accounting of all expenses. The report must be submitted within one month of project completion to the ONS Director of Membership and Component Relations. IMPORTANT: Any unused funds must be returned to ONS within 60 days of the project’s completion. If returning unused funds, make check payable to: Oncology Nursing Society, remit to: ONS Finance, 125 Enterprise Drive, Pittsburgh, PA, 15275 (please write ‘Lilly Project’ in memo line).
Compliance statement and e-signature
I certify that all information provided on this application is accurate to the best of my knowledge, and if my project is accepted, I will adhere to the requirements of this program.
Electronic signature (please type your full name here):
Date submitting this form:
(continued next page) After completing all required items above (or via separate supporting documentation), please submit this application and any supporting documentation to:
ONS Awards: [email protected]
(Note: only email submissions of this form and/or your supporting documentation can be accepted – no faxes or hard-copies permitted. If submitting separate documents, please be sure to include your last name within the document title for each document submitted.)
Thank you!