Application Form for Research Funds

SIGMA THETA TAUDELTA OMICRON CHAPTERApplication Form for Research FundsDateTitle of Project(Please limit to 56 characters)Information Regarding Applicant:Principal Investigator:Home Address:City/State:StreetZip Code:Home Phone: ( ) Business Phone: ( )E-Mail Address:Registered in the State of:License No.Sigma Theta Tau Membership: Yes No Chapter:Have you previously received a Delta Omicron Chapter Research Award?Yes Date Received: NoHave you applied for or are you now receiving support for this research?Yes No(If yes, please identify agency and amount requested/awarded)Co-Investigators: YesNo(If yes, please include curriculum vitae)1). Name:Address:Home Phone: ( ) Business Phone: ( )E-Mail:

2). Name:Address:Home Phone: ( ) Business Phone: ( )E-Mail:Human Subjects: Yes NoInstitutional Review Board Action: (Include copy of approval)Approval DateComment:Total amount of budget requested $Starting DateCompletion DateRESEARCH GRANT AGREEMENT1. To use the grant for research project as described in the application and return any excessfunds to the Treasurer of Sigma Theta Tau, Delta Omicron Chapter.2. To send one copy of a project summary including findings of the project to Delta OmicronChapter within six months of completion date.3. To acknowledge the assistance of Sigma Theta Tau, Delta Omicron Chapter in anyappropriate way in connection with the completed research project.4. To publish and/or present the research findings to the Delta Omicron Chapter.5. Will not accept duplicate funding.6. To accept responsibility for the scientific conduct of the project if a grant is awarded as aresult of this application.Signature of Principal InvestigatorDate

SIGMA THETA TAUDELTA OMICRON CHAPTERDetailed Budget for Proposed ResearchName:Dates From:Through:Justify all expenditures in the space provided. Use additional pages if necessary. Sigma Theta Taudoes not fund overhead costs, tuition, or investigator salaries.Personnel(Salaries for investigators will not be funded. Include hourly rate for personnel.)AmountTyping cost (must be those directly related to research)*Typing of dissertations will not be fundedResearch assistantsSecretarial staffOther (please specify)Supplies (Include only when not provided by institution)AmountEquipmentAmountTravel(Include travel related to conducting research, not presentation of research, nor consultationwith dissertation committee.)Computer costs (Include only when not provided by institution)AmountAmountOther expensesAmountTOTAL: