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Evidence for Action: Investigator-Initiated Research to Build a Culture of Health Open Call for Proposals Eligibility Criteria* Instruction: Respond to the question below to indicate whether the applicant meets these conditions. Preference will be given to applicant organizations that are either institutes of higher education, public entities or nonprofit organizations that are tax-exempt under Section 501(c)(3) of the Internal Revenue Code but other types of nonprofit and for-profit organizations are eligible to apply. Applicant organizations must be based in the United States or its territories. 1. Does the applicant organization meet these criteria? * Yes No SAMPLE - PAGE 1 OF 16

Evidence for Action: Investigator-Initiated Research to Build a Culture of Health Open Call for Proposals Applicant Organization and Tax Verification * Instruction: Provide the following information about the applicant organization. Include the formal legal name of the organization that, if awarded, will receive grant funds. Note: If the Applicant Organization is a college or university, include the appropriate school, department or unit. You may use the "Select organization information" link below to facilitate the entry of data required below. If the information already exists in the GuideStar Exchange or from prior activity with RWJF, the fields below will become prepopulated with the required data. If that occurs, please be sure to proofread the prepopulated information to ensure that it is accurate and current. Feel free to edit as needed. Use this link to learn more about this feature. If, instead, you prefer to manually enter all the required information below, you may do so. Organization * School/Department/Unit Address * Address (line 2) City* State / Territory * Zip Code + 4-digit extension * SAMPLE - PAGE 2 OF 16

Phone Number * Fax Number Website Tax Verification 1. Applicant Organization Tax ID (Employer ID Number) 2. Is the applicant organization any of the following: tax-exempt under section 501(c)(3) of the Internal Revenue Code, a state university, or a governmental entity? * Yes No 3. Is the applicant organization a private foundation or a Type III supporting organization? * Yes No SAMPLE - PAGE 3 OF 16

Evidence for Action: Investigator-Initiated Research to Build a Culture of Health Open Call for Proposals Key Contacts * Instruction: Provide information for the contacts listed below. To save your partially completed page, scroll to the bottom of this page and select "Save, continue editing" or "Save, return home." Use the "Copy" feature to copy completed organizational and address information to a new contact. Choose a role from the drop-down menu and select the "Copy" button. If the Key Contact Organization is a college or university, include the appropriate school, department, or unit. You may use the "Select contact information" link below to facilitate the entry of data required below. If the information already exists in the GuideStar Exchange or from prior activity with RWJF, the fields below will become prepopulated with the required data. If that occurs, please be sure to proofread the prepopulated information to ensure that it is accurate and current. Feel free to edit as needed. Use this link to learn more about this feature. If, instead, you prefer to manually enter all the required information below, you may do so. Principal Investigator * This is the person with the responsibility for overseeing the project. This person will be the primary recipient of all key Foundation correspondence: copy of award notice, post-award financial and monitoring, and grant closure. Additionally, after the application is submitted, this person will be asked to provide feedback to an independent survey firm on the application process and applicant characteristics in a brief, online survey. RWJF will share this person's contact information, including email address, with the survey firm for the sole purpose of soliciting feedback. Email * Confirm Email * Prefix First Name * SAMPLE - PAGE 4 OF 16

Middle Name Last Name * Suffix Degree(s) * Organization * Position * School/Department/Unit Address * Address (line 2) City * State / Territory * Zip or Postal Code * Office Phone Number * Phone ExtnSAMPLE - PAGE 5 OF 16

Cell Phone Number Co-Principal Investigator If applicable, provide the following information for the project co-principal investigator who will share responsibility for this project. This person will also receive all key Foundation correspondence as described above. Email * Confirm Email * Prefix First Name * Middle Name Last Name * Suffix Degree(s) * Organization * Position *SAMPLE - PAGE 6 OF 16

School/Department/Unit Address * Address (line 2) City * State / Territory * Zip or Postal Code * Office Phone Number * Phone Extn Cell Phone Number Alternate Contact The Alternate Contact should be the Principal Investigator's assistant or another person we can contact if the Principal Investigator is unavailable. Email * Confirm Email * Prefix SAMPLE - PAGE 7 OF 16

First Name * Middle Name Last Name * Suffix Degree(s) Organization * Position * School/Department/Unit Address * Address (line 2) City * State / Territory * Zip or Postal Code * SAMPLE - PAGE 8 OF 16

Office Phone Number * Phone Extn Cell Phone SAMPLE - PAGE 9 OF 16

Evidence for Action: Investigator-Initiated Research to Build a Culture of Health Open Call for Proposals Project Summary Instruction: Provide the following information for your proposed project: Title Requested amount Proposed start date Anticipated duration Statement of impact Title * Requested Amount $ * Proposed Start Date * Anticipated duration * months Statement of Impact * Please provide a brief 500 character statement (approximately 2-3 sentences) about the expected impact of this research. Please also let us know if your ability to conduct this research is contingent upon the proposed start date? If so, please provide a brief explanation. SAMPLE - PAGE 10 OF 16

Evidence for Action: Investigator-Initiated Research to Build a Culture of Health Open Call for Proposals Applicant Questions* Instruction: For internal planning purposes, we need to gather information about our applicant pool. Responses to the following questions are not used in evaluating applications, but will be used to help improve the CFP dissemination strategy. 1. What sector does the principal investigator represent? * Academic Government Non-Profit Other (specify below) 2. If answer to question one is Academic: What academic discipline does the principal investigator represent? * Select all that apply. Anthropology Architecture Biology Business Economics Education Engineering Epidemiology Design Healthcare Other (please explain) 3. If answer to question one is Government: What level of government does the principal investigator represent? * Local Regional State Federal Other (please explain) Health Services Law Medicine Nursing Psychology Political Science Public Policy Public Health Sociology Urban Planning SAMPLE - PAGE 11 OF 16

4. If the answer to question one was Government: What division of government does the principal investigator represent? * Select all that apply. Public Health Health Care Social Services School District Other (please explain) Transportation Planning Public Works Parks & Recreation 5. If the answer to question one is Non-Profit: Is the primary focus non-profit health? * Yes No 6. If the answer to question five is "No", what is the primary focus of the non-profit? * Select all that apply. Asset Building Education Environment Faith Based Labor Law Other (please explain) 7. Are you proposing to conduct research in partnership with a sector or discipline different from that of the principal investigator (e.g., is this work cross-disciplinary or cross-sectoral)? * If "Yes," please explain partnering sector/discipline (maximum of 250 characters, including spaces). No Yes 8. How did you learn about this funding opportunity? * Select all that apply. Other (please explain) Public Policy Social Justice Social Services Transportation From an electronic mailing list Urban Planning/Design/Architecture From a colleague in the same organization From a colleague in a different organization At a national meeting From the RWJF Web site From the Evidence for Action program Web site SAMPLE - PAGE 12 OF 16

Evidence for Action: Investigator-Initiated Research to Build a Culture of Health Open Call for Proposals Letter of Intent * Instruction: To Begin: Download the template shown below. Follow the instructions included on the template. To Upload: Upload the completed document(s) by selecting the "Upload" button below. For assistance with uploading, refer to the "Upload Documents" section of the "Applicant Guide," (see "Resources" area on the left). When you have completed this page, select the "Save, section finished" button at the bottom of the page. Once all sections of your application are complete, you may "Submit" from the Home page. All uploaded documents may be updated and replaced until you submit your application. Description Templates Uploaded Documents Letter of Intent * Download the template in the "Templates" column to the right, and follow the instructions carefully. To maintain the original formatting, you must convert your document to a PDF prior to uploading. For additional information, refer to "Troubleshooting Tips," (see "Resources" area on the left). Maximum of two pages. Letter of Intent Narrative SAMPLE - PAGE 13 OF 16

Evidence for Action: Investigator-Initiated Research to Build a Culture of Health Open Call for Proposals Curricula vitae/resumes/biosketches * Instruction: Follow the instructions below to provide a CV/resume/biosketch for key program staff members. Curricula vitae/resumes/biosketches should include information on education, professional experience, years in research, publications and previous research. You may upload a separate CV/resume/biosketch for the principal investigator and one other key project staff (if applicable). You may use a National Institutes of Health (NIH) or National Science Foundation (NSF) bio-sketch. For a hard copy CV/resume/biosketch, you should scan each one individually and save to your computer as a PDF. To upload, select the Upload button found in the "Uploaded Documents" column. For an electronic CV/resume/biosketch, you should save each one individually to your computer as a PDF. To upload, select the Uploadt button found in the "Uploaded Documents" column. NOTES: Save your CV/resume/biosketch as a PDF. In the Resources area on the left of the online system, you will find the Applicant Guide. Within the guide, there are links to Upload Documents and Troubleshooting Tips for converting your document to a PDF. The maximum page-limit per CV/Resume/Biosketch is 30. The maximum number of CVs/Resumes/Biosketches is two. You may upload more than one CV/Resume/biosketch individually. After each upload, another Upload button will appear. A Remove button will also appear, in case you need to delete a document. Description Templates Uploaded Documents Curricula vitae/resumes/biosketches * To maintain the original formatting, you must convert your document to a PDF prior to uploading. For additional information, refer to "Troubleshooting Tips," (see "Resources" area on the left). Maximum of two 30-page documents. SAMPLE - PAGE 14 OF 16

Evidence for Action: Investigator-Initiated Research to Build a Culture of Health Letter of Intent Narrative Identifying Information Project Title: (your project title goes here) Letter of Intent I.D.: (your letter of intent ID goes here found in the upper right corner of any screen in this online system) Applicant Name: (your principal investigator s name goes here) Legal Name of Applicant Organization: (legal name of applicant organization goes here) Instructions for using this template. This template is to be used to provide your letter of intent narrative. You should: Print this template in its entirety before you begin, so you have the instructions available at all times. Complete the identifying information shown above this block of instructions. This must be included at the top of the first page and counts toward the two-page limit. Describe your project in the letter of intent section below (maximum of two pages), single spaced. Your description should address three major questions: Rationale (<½ pg) - What will be gained from this work? This should include a statement of the key gaps in knowledge that will be addressed and how findings can be used to improve health outcomes, increase health equity, and inform the Action Framework. Focus on why the research as opposed to the issue is important, and how the results will inform decision-making. Research approach and activities (>1 pg) - What are the specific research question(s) or hypotheses that will be examined and how will this be accomplished? This should include a summary of the proposed research design (i.e. randomized trial, quasi- or natural experiment, observational, etc.), methods that will be used, the study setting and population, and plans for data collection and analysis. Research Team (1 paragraph) - What are the qualifications and capacity of the team to conduct the proposed research? This should include information otherwise not represented in the CV/Resume of the PI or Co-PI, such as additional investigators and capacities, unique partnerships or collaborations, etc. Delete this block of instructions before uploading your proposal narrative. Save your final proposal narrative as a PDF. In the Resources area on the left of the online system, you will find the Applicant Guide. Within the guide, there are links to Upload Documents and Troubleshooting Tips for converting your document to a PDF. Upload the PDF to the Proposal Narrative section of the online system. NOTES: Your letter should be typed in 11-point Arial font and black type. The entire letter, including section headings, should be no more than two pages with single spacing and one-inch margins on the top, bottom and sides of the page. Citations are not needed at this stage; if included, they will count against the two page maximum. You will not be able to upload a document that is longer than two pages. SAMPLE - PAGE 15 OF 16 Page 1 of 2

Do not adjust the margins or font style/size of this template. No hardcopy materials will be accepted as part of your online submission. The Call for Proposals, Frequently Asked Questions, informational videos, and other resources are available at evidenceforaction.org/applicants. Remember to delete this block of instructions before uploading this template. Letter of Intent Narrative (Your letter of intent narrative goes here. Do not exceed two pages, single spaced.) SAMPLE - PAGE 16 OF 16 Page 2 of 2