Research Proposal Form
Notify us as soon as you are planning a research proposal, no later than one-month prior to submission deadline for external applications, and expected start date for other applications. Please also note that full proposals should be ready for submission 24-hours prior to sponsor's deadline.
Your Full Name (Principal Investigator)
*
First Name
Last Name
Your Email Address
*
example@example.com
Please select email address of your Department Chair
*
DenialA@neco.edu
KoevaryS@neco.edu
LyonsS@neco.edu
Not Applicable
Proposal Submission Deadline or Expected Start Date (if applicable)
-
Month
-
Day
Year
Date
Internal or External Funding? List Agency or Sponsor (if applicable)
Project start and end dates?
If Federal application, please provide Funding Opportunity Number (if applicable)
Does this project involve participation of...(please choose one)
Humans, including past records, samples, and questionnaires
Animals
If animal research, please confirm you have obtain IACUC approval prior to study initiation.
Yes
Please confirm you have received IRB approval or exemption from this study prior to initiation.
Yes
No
Does this proposal involve the use of patient data from one of the NECO clinics or other external institutions (check all that apply)
*
Yes- NECO owned/operated clinics
Yes- CHC clinics or outside clinics not affiliated with NECO
External collaborators and/or institutions
No
If the research is taking place in a clinical setting, have you discussed the study with your clinical manager during the development of the study?
Yes
No
Please list any/all clinical resources needed for your research, such as exam room space, patient recruitment materials, etc.
If Yes, please describe your method of data collection and how the clinical data will be protected and/or encrypted
Please provide the estimated duration of the study, indicating start and end date of data collection
For RESIDENTS or STUDENTS, please provide the name and email of Faculty Supervisor/Mentor
For Faculty, has your Department Chair or Supervisor been informed regarding any FTE requirements?
Yes
No
Please describe the study personnel/team. Include each team member's role.
Are you requesting DOR assistance with proposal preparation and/or is a budget required for submission to Sponsor?
Yes- full proposal assistance (i.e., https://grants.nih.gov/grants-process/write-application/how-to-apply-application-guide)
Yes- proposal budget only
No- neither full proposal nor budget/funds are being requested
Brief description of the proposal including approximate budget amount
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