Homer Grant Application Worksheet

v1.2 (21st July 2017)

HOMER GRANT APPLICATION WORKSHEET

Please DO NOT submit this worksheet as your application. This worksheet is meant for applicants to prepare for submitting your grant application.

Only online applications are accepted.

Please tick (ü) the category of grant for your proposal:

/ Category A (up to $5,000 for 1 year) / / Category B (up to $10,000 for up to 2 years)

Please tick (ü) the relevant research area(s) of proposed research:

/ Interprofessional Education and Collaborative Practices (IPECP)
/ Work-based Learning
/ Faculty Development
/ Others ______
Project Title:

Please copy-&-paste additional sections for PI, co-Investigator, or collaborator as required for your application preparation.

A. Principal Investigator 1 (contact PI)
Salutation:
Full Name:
Institution:
Department:
Designation:
Contact number: / (Office) / (Mobile)
Email:
A. Principal Investigator 2
Salutation:
Full Name:
Institution:
Department:
Designation:
Contact number: / (Office) / (Mobile)
Email:
A. Principal Investigator 3
Salutation:
Full Name:
Institution:
Department:
Designation:
Contact number: / (Office) / (Mobile)
Email:
B. Co-Investigator 1
Salutation:
Full Name:
Institution:
Department:
Designation:
Contact number: / (Office) / (Mobile)
Email:
B. Co-Investigator 2
Salutation:
Full Name:
Institution:
Department:
Designation:
Contact number: / (Office) / (Mobile)
Email:
C. Collaborator 1
Salutation:
Full Name:
Institution:
Department:
Designation:
Contact number: / (Office) / (Mobile)
Email:
C. Collaborator 2
Salutation:
Full Name:
Institution:
Department:
Designation:
Contact number: / (Office) / (Mobile)
Email:
D. Project Details
D1. Research question(s) and hypotheses (if any):
(please limit to 3000 characters, ~ 500 words)
D2. Context / empirical / background literature of proposed research areas(s) relevant to the research project:
(please limit to 9000 characters, ~ 1500 words)
D3. Importance of proposed research question(s) and potential contribution to theory and practice of health professions education:
(please limit to 3000 characters, ~ 500 words)
D4. Please provide details if the proposed research project is a development of a previous project:
(please limit to 3000 characters, ~ 500 words)
D5. Details of the research methodology and data analysis:
(please limit to 9000 characters, ~ 1500 words)
D6. Role and duties of PI(s) and collaborator(s)
# / Name, Institution / Role
(PI, Collaborators etc) / Specific Duties / Expertise for Research Project
1
2
3
D7. Projected timeline / Milestones
# / Activity / Time needed
(in weeks) / Month – Year
(e.g., recruiting research assistants, data collection, pilot testing, submission of progress and final reports, etc)
1
2
3
E. Budget
# / Description of item / Purpose / Estimated quantity and cost per unit / Estimated amount
1
2
3
4
5
Total grant amount requested: / $

Please DO NOT submit this worksheet as your application. This worksheet is meant for applicants to prepare for submitting your grant application.

Only online applications are accepted.