APPLICATION FORM SIGMA THETA TAU XI CHAPTER RESEARCH GRANTS Next Deadline: Friday, February 16, pm

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1 APPLICATION FORM SIGMA THETA TAU XI CHAPTER RESEARCH GRANTS Next Deadline: Friday, February 16, pm ATTENTION: All Xi Chapter Research Grants will now be submitted ONLINE! Please follow the instructions below. Those awarded grants MUST attend the Student/Faculty/Alumni Ceremony on Friday, May 11, Title of study: 2. Name(s) of Applicant(s) + Credentials: Applicant's Home/Business Address: Applicant's Telephones: Home: Business: Address: Include a copy of the Curriculum Vitae or Biographic Sketch of each investigator in the Appendix to this grant application. 3. Is the Applicant a member in good standing of the Xi Chapter of Sigma Theta Tau at the time of this application?:

2 Yes: No: Member Number: 4. Have you applied for or are you now receiving support for this research? Yes: No: If yes, please list source(s) of funding and amount requested: Source(s) of funding: Amount(s) requested/funded: If funding decision pending, date(s) of notification: If other support is received after this application is submitted, please notify the Xi Chapter Research Committee Chairperson (Desiree Fleck) 5. Has this application been submitted for Human Subjects (Institutional Review Board) approval? Yes: No: (explain) If yes, which institution(s)? If Human Subjects approval has been granted, include the approval form in the Appendix to the grant application. 6. Please complete if Principal Investigator is a student: University and school or department: Degree sought: Expected date: Major: Names of Research Advisors/Dissertation Committee members: FORMAT FOR PROPOSAL: 1. Title and Abstract [Abstracts greater than 150 words will not be accepted]

3 The first page of the proposal includes the title and a 150 word abstract. The abstract is to include the specific aims of the research, methodology (including design, sample, instruments), and data analysis procedures. 2. Budget List amount and provide justification for major expenditures. If the proposed study is going to be funded by multiple sources, the entire budget for the research study must be included. Indicate those items for which for which Xi Chapter, Sigma Theta Tau funding is requested. Prioritize items for Xi Chapter funding. Funding may be requested from Xi Chapter for the following items: a. Personnel (Please note that Principal/Co-Investigator(s) salaries cannot be included in the budget.) b. Consultants c. Supplies d. Equipment e. Local Travel (Xi Chapter research fund is not sufficient to support travel to professional meetings.) f. Other Expenses (Itemize) 3. Research Plan [Any Research Plan Exceeding 10 pages will not be accepted] Do not exceed 10 single-spaced typewritten pages for a-d. All type must be 12 font or larger. Minimum of 1 inch margins on all sides. a. Specific Aims: State concisely and realistically what the research described in this proposal is intended to accomplish and/or what questions/hypothesis(es) is/are to be answered/tested. b. Background and Significance: Briefly describe the background to the present proposal, critically evaluate existing knowledge, and specifically identify the gaps that the research is intended to fill. Identify and briefly describe the theoretical model upon which the research is based. Provide theoretical definitions for study variables. State concisely the importance of the research by relating the specific aims to longer term objectives. Do not exceed three single-spaced pages. c. Preliminary Work: If applicable, describe the investigator's preliminary studies pertinent to the proposed research.

4 d. Design and Methods: Discuss in detail the design and methods to be used to accomplish the specific aims of the research. The description of the design should identify the type of research proposed (e.g., descriptive, experimental, longitudinal, cross-sectional). The description of methods should include the following areas: 4. Facilities and Resources (1) Sample characteristics and size. Describe the characteristics of research subjects and sampling criteria. Provide a rationale for the sample size. Indicate how subjects will be recruited. (2) Instruments. Identify each instrument to be used and state which study variable will be measured by each instrument. Discuss validity, reliability, and scoring procedures for each instrument. Include a copy of each instrument in the Appendix. (3) Data collection procedures. Describe the procedures to be used for data collection. Indicate when and how informed consent will be obtained from subjects. (4) Data analysis plan. Describe the data analysis procedures to be used for each specific aim/question/hypothesis. (5) Time table. Provide a time table for each phase of the research. (6) Human subjects considerations. Indicate if the study has been approved by the appropriate Human or Animal Subjects Committee(s). Include letters of approval and a copy of the consent form (if applicable) in the Appendix. List the facilities to be used for the research and the resources available to the investigator(s). Include letters granting access to study populations in the Appendix. 5. Literature Cited List only those works cited in the research plan. 6. Appendix Include Curriculum Vitae or Biosketches of all investigators and consultants, consent form(s), instruments, human subjects approval(s), and letters of support from

5 consultants and data collection sites (if any). Letters attesting to the ability of the investigator(s) to conduct the research also may be included. The section below is to be completed by the Xi Chapter Research Committee Chairperson: Approval date: Amount of award: Progress report(s) received (list date(s)): Date of study completion: Funds used: Funds returned: Final report date: Xi Chapter Research Committee Chairperson: INSTRUCTIONS FOR SUBMISSION: 1. CUT AND PASTE THIS APPLICATION AND PROPOSAL FORMAT ABOVE INTO MICROSOFT WORD AND SEND ONE COPY VIA ATTACHMENT TO: 2. APPLICATIONS MUST BE RECEIVED NO LATER THAN FRIDAY, FEBRARY 16, YOU WILL RECEIVE AN CONFIRMING THAT WE HAVE RECEIVED YOUR APPLICATION. 3. ADDITIONALLY, A HARD COPY OF THE RESEARCH PROPOSAL AND ALL LETTERS OF SUPPORT AND THE SIGNED RESEARCH AGREEMENT MUST BE SUBMITTED NO LATER THAN FRIDAY, FEBRUARY 16, 2018 at 5pm. THESE

6 SAME PROCEDURES SHOULD ALSO BE APPLIED FOR LETTERS FROM DATA COLLECTION SITES. 4. PRINT THE RESEARCH GRANT AGREEMENT BELOW AND OBTAIN SIGNATURES. THIS FORM SHOULD BE SUBMITTED WITH THE HARD COPY OF THE RESEARCH PROPOSAL ON FRIDAY, FEBRUARY 16, 2018 at 5pm. ****NOTE THAT THERE IS A LINK TO THE XI CHAPTER RESEARCH GRANT PROGRESS REPORT IN THE INSTRUCTIONS BELOW FOR THE RESEARCH GRANT AGREEMENT (3). MARK YOUR CALENDARS! NO EXCEPTIONS WILL BE MADE. THIS PROGRESS REPORT SHOULD ALSO BE SUBMITTED TO Xi Chapter VIA ATTACHMENT by May 1 st of each year annually, until the study is completed. RESEARCH GRANT AGREEMENT SIGMA THETA TAU XI CHAPTER RESEARCH AWARDS If this proposal is approved for funding, I (we) agree to the following conditions: 1. Accept responsibility for the scientific conduct of this study. 2. Be present at Student/Faculty/Alumni Award Ceremony, May 11, 2018 to receive funding 2. Expend the funds as described in the proposal, deposit all funds by June 15, 2018 and return unused funds to the Treasurer of Xi Chapter. 3. Submit a progress report annually until the study is completed. Please note: all grantees will be expected to submit the Xi Chapter Research Grant Progress. This report will be due on May 1 st of each year annually until the study is completed. This progress report should be submitted online via to Xi Chapter. A final grant report is to be submitted upon study completion to Xi Chapter. 4. Acknowledge the grant support of Xi Chapter of Sigma Theta Tau in any publications and/or presentations of the research findings. 5. Publish or present the findings of the research in a program sponsored by Xi Chapter if invited to do so.

7 Principal Investigator Signature: Date: Co-Investigator Signature(s) (all must sign): Date: Expected date of start of data collection: Expected date of final progress report: Name to whom the check should be written if you are to receive this award: 2013 Sigma Theta Tau International, Xi Chapter

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