Request for Funding to Support Phd Student Research
UW-Madison School of Nursing
Request for Funding to Support PhD Student Research
Spring 2017
· The School of Nursing offers several awards to support student research including data collection, the development of research ideas and professional development.
· Requests for funding for travel is limited to support research/data gathering or conference attendance if you are NOT planning to present. Other funding is available through Academic Programs for conference travel if you are presenting and should not be requested in these budgets.
· Please review the information below regarding eligibility and specific application processes for each award.
· Applications for all awards are due by 4:30 pm on January 23, 2017.
PurposeTo support development of research/scholarly interests and/or a proposed research study.
Evaluation Criteria
Quality of the research (significance, methodological rigor, innovation, impact on nursing knowledge or practice)
Evidence that proposed activity supports the student in establishing or furthering his/her research interest
Application Materials
(Submit only ONE Funding application face page)
Save as Last_Name 2017 Research Funding Face Page.pdf and send to Carol Aspinwall,
Eckburg Dissertation Award / Heideman Award / Class of 1964, Larson, & Johnson Award / Long Term Care Leadership
“To support applied research with a goal of direct and positive impact on the care of the elderly.” / Eckburg Award
Max $1000 / Max $3000 / Max $1000 / Max $3000 / Max $4,000
For Dissertation, Heideman, Class of 1964, Larson and Johnson Research Awards; Long Term Care Leadership* Submit: / For Eckburg Award Submit:
1) Budget and justification
2) Research Plan (3 pages)
3) CV
4) For the LTC Award only: A statement indicating how this research will support applied research with a goal of direct and positive impact on the care of the elderly.
Save as Last_Name 2017 Research Award.pdf and send to / Items 1-2 (noted under other awards) PLUS
3) Project Summary (Abstract)
4) NIH-style Biosketches for applicant and all co-investigators
Save as Last_Name 2017 Eckburg Award.pdf and send to
Note: Students applying for Eckburg awards may not be in any way related to any member of the Charles Eckburg Foundation Board of Directors.
All applications will be reviewed and scored by the Admissions, Progression, Funding Subcommittee of the Graduate Programs Committee. Students will be notified of awards by late-January 2017. Funds will be available in February 2017.
Funding Application Face Page
(Submit only ONE for all of the awards)
Instructions: Complete this form, print it, obtain signatures and scan.
Save as Last_Name 2017 Funding Face Page.pdf
Send to Carol Aspinwall,
Project Title:Your Name:
Faculty Advisor(s):
Office or Campus Address:
Email:
Phone:
Which awards are you applying for (check all that apply)
Eckburg Dissertation Award (up to $1,000.00)
Has your committee approved your dissertation proposal? Yes No
If no, when do you expect it will be approved?
Eckburg Award (up to $4,000.00)
Heideman Award (up to $3,000.00)
Class of 1964, Larson, Johnson Award (up to $1,000.00)
Long-Term Care Leadership (up to $3,000.00)
Please list other research funding received in past years / pending:
Student’s Signature
Faculty Advisor’s Signature
Budget and Justification
(Submit a specific budget for the appropriate award amount)
r Up to $1,000 for Eckburg Dissertation/Class of 1964/Larson/Johnson
r Up to $3,000 for Heideman
r Up to $3000 for Long-Term Care
r Up to $4000 for Eckburg
Eckburg Dissertation, Class of 1964, Larson or Johnson / Heideman / LTC-Leadership / EckburgBudgeted Limit / $1,000 / $3,000 / $3,000 / $4,000
Personnel (Applicant’s salary is not allowable.) Describe:
Consultant Costs List agency or affiliation:
Equipment Describe:
Supplies Describe:
Travel Describe purpose or list conference organization, date, relevance. Are you planning to present? Just attending?
(Request funding for travel only if you have already utilized your $1,000.00 2016-2017 conference travel funds to do a presentation through Academic Programs.)
Other Describe:
Total
SAMPLE BUDGET / Ranges: $1,000- $4,000
Personnel
Student Hourly: An undergraduate student will be hired for 20 hours [$10/hr.] to complete mailings, track survey responses, and enter data. / $200
Consultant Costs
J. Smith: J. Smith, Associate, Biggest and Best Survey Center, will provide 2 hours of consultation time [$50/hr.] to review the survey and provide feedback on item wording, layout, etc… / $100
Equipment
None / $0
Supplies
Important Nursing Organization (INO) Mailing List: Mailing addresses of a random sample of 100 INO members who have identified their practice role as “staff nurse” will be purchased at the non-profit rate [$50 per one hundred records]. The mailing list will cost $100 plus a $25 processing fee, a $15 set-up fee, and approximately $10 shipping and handling fee [total = $150].
Mailing Needs
A total of $ is requested for mailing needs. Approximately 10 reams of paper [$4 each] will be needed for surveys and cover letters. We will need 400 envelopes [$13 per 500 envelopes] and 200 adhesive mailing labels [$5 per 100 labels]. Postage to mail the survey and return envelope is $0.60 per piece and to return the completed survey is $0.44 per piece. / $371
Travel
A total of $44 is requested for one round trip by auto to Milwaukee, WI to meet with J. Smith of the Biggest and Best Survey Center to discuss feedback on survey design [UW standard rate $0.51 per mile, 85 miles]. / $44
Other
Participant Incentives: A total of $275 is requested to offer five $50 VISA gift cards in a drawing among persons who complete the survey. A service charge of $5 per card is charged by US Bank. Entry in a prize drawing is a method commonly used to enhance survey participation rates.
/ $275
Total / $990
SAMPLE BUDGET / Eckburg Award
Up to $4,000
Personnel
Student Hourly: An undergraduate student will be hired for 50 hours [$10/hr.] to complete mailings, track survey responses, and enter data. / $500
Consultant Costs
J. Smith: J. Smith, Associate, Biggest and Best Survey Center, will provide 3 hours of consultation time [$50/hr.] to review the survey and provide feedback on item wording, layout, etc. / $150
Equipment
None / $0
Supplies
Important Nursing Organization (INO) Mailing List: Mailing addresses of a random sample of 400 INO members who have identified their practice role as “staff nurse” will be purchased at the non-profit rate [$50 per one hundred records]. The mailing list will cost $100 plus a $25 processing fee, a $15 set-up fee, and approximately $10 shipping and handling fee [total = $150].
Mailing Needs
A total of $ is requested for mailing needs. Approximately 10 reams of paper [$4 each] will be needed for surveys and cover letters. We will need 400 envelopes [$13 per 500 envelopes] and 200 adhesive mailing labels [$5 per 100 labels]. Postage to mail the survey and return envelope is $0.60 per piece and to return the completed survey is $0.44 per piece. / $621
Travel
A total of $176 is requested for four round trips by auto to Milwaukee, WI to meet with J. Smith of the Biggest and Best Survey Center to discuss feedback on survey design [UW standard rate $0.51 per mile, 85 miles].
Attendance at the Professional Association to present results / $176
$2,000
Other
Participant Incentives: A total of $275 is requested to offer ten $50 VISA gift cards in a drawing among persons who complete the survey. A service charge of $5 per card is charged by US Bank. Entry in a prize drawing is a method commonly used to enhance survey participation rates.
/ $550
Total / $3,997
Research Plan (3 page single-spaced, .05 margins, 11 point Arial font)
Summary of the proposed research or project
· Specific aims.
· Background, significance, innovation, methods, and impact on advancing nursing knowledge.
· Preliminary data (if any).
· Methods.
· Anticipated results and indication of next step (subsequent study or application for extramural support).
Explanation of how the proposed activity supports the student in establishing or furthering his / her research interests or scholarly inquiry.
Eckburg Award Only
Project Summary
(This form is similar to what you would submit for National Institutes of Health (NIH) funding)
The first and major component of the Description is a Project Summary. It is meant to serve as a succinct and accurate description of the proposed work when separated from the application. State the application's broad, long-term objectives and specific aims, making reference to the health relatedness of the project (i.e., relevance to the mission of the agency). Describe concisely the research design and methods for achieving the stated goals. This section should be informative to other persons working in the same or related fields and insofar as possible understandable to a scientifically or technically literate reader. Avoid describing past accomplishments and the use of the first person.
PROJECT SUMMARY:Eckburg Award Only
(this form is similar to what you would submit for National Institutes of Health (NIH) funding)
BIOGRAPHICAL SKETCH
Provide the following information for the Senior/key personnel and other significant contributors.Follow this format for each person. DO NOT EXCEED FOUR PAGES.
NAME / POSITION TITLE
eRA COMMONS USER NAME (credential, e.g., agency login)
EDUCATION/TRAINING (Begin with baccalaureate or other initial professional education, such as nursing, include postdoctoral training and residency training if applicable.)
INSTITUTION AND LOCATION / DEGREE
(if applicable) / MM/YY / FIELD OF STUDY
Further Instructions to complete the Biosketch:
Following the educational block, complete sections A, B, C and D:
A. Personal Statement. Briefly describe why your experience and qualifications make you particularly well-suited for your role (e.g., PD/PI, mentor, participating faculty) in the project that is the subject of the application. Within this section you may, if you choose, briefly describe factors such as family care responsibilities, illness, disability, and active duty military service that may have affected your scientific advancement or productivity.
B. Positions and Honors. List in chronological order previous positions, concluding with the present position. List any honors. Include present membership on any Federal Government public advisory committee.
C. Selected Peer-reviewed Publications. NIH encourages applicants to limit the list of selected peer-reviewed publications or manuscripts in press to no more than 15. Do not include manuscripts submitted or in preparation. The individual may choose to include selected publications based on recency, importance to the field, and/or relevance to the proposed research. When citing articles that fall under the Public Access Policy, were authored or co-authored by the applicant and arose from NIH support, provide the NIH Manuscript Submission reference number (e.g., NIHMS97531) or the PubMed Central (PMC) reference number (e.g., PMCID234567) for each article. If the PMCID is not yet available because the Journal submits articles directly to PMC on behalf of their authors, indicate "PMC Journal - In Process." A list of these Journals is posted at: http://publicaccess.nih.gov/submit_process_journals.htm. Citations that are not covered by the Public Access Policy, but are publicly available in a free, online format may include URLs or PubMed ID (PMID) numbers along with the full reference (note that copies of publicly available publications are not acceptable as appendix material.)
D. Research Support. List both selected ongoing and completed research projects for the past three years (Federal or non-Federally-supported). Begin with the projects that are most relevant to the research proposed in the application. Briefly indicate the overall goals of the projects and responsibilities of the key person identified on the Biographical Sketch. Do not include number of person months or direct costs. Do not confuse "Research Support" with "Other Support." Though they sound similar, these parts of the application are distinctly different. As part of the biosketch section of the application, "Research Support" highlights your accomplishments, and those of your colleagues, as scientists. This information will be used by the reviewers in the assessment of each individual's qualifications for a specific role in the proposed project, as well as to evaluate the overall qualifications of the research team. In contrast, "Other Support" information is required for all applications that are selected to receive grant awards and includes detailed financial information (see Part I, 4.6.1). NIH staff will request complete and up-to-date "Other Support" information after peer review. This information will be used to check that the proposed research is not already funded through other sources.