GLATA Research Grant
Applicant (Principal Investigator) Information
Name
*
First Name
Last Name
Credentials
*
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
*
-
Area Code
Phone Number
Fax
-
Area Code
Phone Number
Email
*
example@example.com
NATA Membership # (if applicable)
BOC Cert # (if applicable)
Sponsoring Institution:
*
Sponsoring Institution Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Proposal Information Section
Title of Project
*
Type of Grant
*
Professional ($6,000 max)
Doctoral ($2,500 max)
Master's ($1,000 max)
Pilot ($500 max)
Estimated Total Cost of Project
*
Amount Requested
*
Faculty Advisor (if applicable)
Name
First Name
Last Name
Credentials
Title
Phone Number
-
Area Code
Phone Number
Email
example@example.com
Institutional Official Section
Name
First Name
Last Name
Credentials
Title
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Fax
-
Area Code
Phone Number
Email
example@example.com
GLATA Policy on Disclosure of Affiliation and/or Financial Interest
This must be the second page of the grant application packet. In some cases, those individuals seeking GLATA grants may be affiliated with, or have financial interest in, organizations that may have a direct interest in the subject matter of a grant application. The GLATA must be informed of any such affiliation and/or financial interest on the part of the investigator(s). The intent of this policy is not to prevent a researcher with an affiliation and/or significantly financial interest from receiving grant funds from the GLATA. This policy is intended to identify any affiliation clearly so that committee members may form their own judgements.
Statement of Disclosure
Name
*
First Name
Last Name
Credentials
*
Employer
*
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
*
-
Area Code
Phone Number
Fax
-
Area Code
Phone Number
Email
*
example@example.com
Please list (in the box below) any affiliation(s) and/or significant financial interest(s) you have with any organization(s) that might have a direct interest in the subject matter of your grant. (Example: Part Owner, XYZ Athletic Products, Inc.) If you have no such affiliation or financial interest, simply state "none."
*
Signature
Date
-
Month
-
Day
Year
Date
Grant Application (Includes: Cover Sheet, COI, Summary, Budget and Justification, Proposal, Appendices and References in single PDF)
*
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