Fillable 2019 CISE Application Blank

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2019 CISE Application Blank

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  • 18 check-boxes
  • 68 other fields

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CREATIVE INQUIRY SUMMER EXPERIENCE (CISE) QEP GRANT FORM
Page 1
TTU CISE GRANT APPLICATION FORM
1. COVER SHEET
Project Title:
STUDENT INFORMATION (as of today’s date):
Student ID
Name: T# (required!):
Address: Telephone Number:
Street
TTU Email
Address:
City, State, Zip Code
Major: Minor:
Faculty Mentor: Co-Investigator(s):
Freshman 1
st
year Double click check boxes: *These questions are only for demographic purposes
Classification: Sophomore 2
nd
year *Sex: Male Female Other No Response
Junior 3
rd
year *To which racial or ethnic group(s) do you most identify?
Senior 4
th
year African-American , Asian/Pacific Islanders , Caucasian ,
Latino or Hispanic , Native American or Aleut , Other
Expected Graduate Date:
(Enter Month and Year e.g., September 2019)
Cumulative GPA: Major GPA:
BUDGET: (
food is not allowed)
STIPEND ($3500 maximum)
SUPPLIES
OTHER
TOTAL
(requested from grant)
SIGNATURE
S:
________________________________________
(STUDENT) (DATE)
________________________________________
(FACULTY SPONSOR) (DATE)
CREATIVE INQUIRY SUMMER EXPERIENCE (CISE) QEP GRANT FORM
Page 2
2. FACULTY MENTOR’S SUPPORT FORM
To be completed by faculty mentor. Must be digitally signed and included as part of the CISE grant proposal.
Faculty Mentor Information:
Name: Rank:
College/School : Department:
Telephone: Email Address:
Is IRB Approval Required? Yes No If yes, has it been secured? Yes No
Institutional Review Board for the Protection of Human Subjects at Tennessee Technological University
Is Performance License, Royalties, or Copyright Permission Required? Yes No
If yes, has it been secured? Yes No
Is IACUC Approval Required? Yes No If yes, has it been secured? Yes No
Institutional Animal Care and Use Committee
Has the Student taken all required safety courses? Yes No
If you have more than one student applying for the CISE GRANT, please rank this student/project in comparison to the other
students (1 of 2 , etc.) Rank: of
Faculty Mentor Expectations if CISE grant is awarded (by checking, faculty are agreeing to these conditions):
Faculty will Attend Camp QEP or meet/discuss with Dr. Ed Lisic, or Dr. Lenly Weathers about addressing the five
Student Learning Outcomes (SLO’s) in our QEP. (SLO’s are found in the CISE Application Guidelines PDF)
Grade the five SLO’s using our SLO Rubric (Rubric is found in the CISE Application Guidelines PDF) and return
them to Dr. Lisic by August 28
th
, 2019, after the summer grants are over.
Faculty Mentor Extra Statements (if there is any information pertinent to the student, the grant, or other issues
that aren’t addressed elsewhere in this form please add them here) Maximum 250 words:
Facult
y Mentor Endorsement:
Mentor Signature Date
My department chair is aware of this project and is supportive of the project and my involvement as a faculty mentor.
■
■
■
click to sign
signature
click to edit
CREATIVE INQUIRY SUMMER EXPERIENCE (CISE) QEP GRANT FORM
Page 3
3. CISE BUDGET FORM
(To be developed in consultation with faculty mentor)
Student Name:
Project Title:
DETAILED BUDGET:
Itemize expenses for items not provided through TTU or your faculty mentor. The maximum is $500 for
expenses, if the student is asking for $3500 for stipend. If not, the total budget cannot exceed $4000. (For
example a student could ask for $1000 for expenses, but only $3000 for stipend) Submit separate sheets with
supporting documentation (e.g., product specifications, cost estimates, travel request forms) if appropriate. The
budget page should include a list of the items within categories (i.e., supplies, personal protective equipment,
services, equipment, mileage, etc.) and a justification of any unusual items. Round to the nearest dollar. If the
total project costs exceed the $4000 for summer grants, then list any other sources of support (SMAC 606, other
grants) on a separate additional sheet.
Expense Items
Estimated Costs
$
$
$
$
$
$
Travel (not for dissemination of your work at a conference)
$
Stipend ($3500 Maximum)
$
Total Budget Request:
$
All funds for expense items, such as materials, supplies, equipment, software, computers, resources, or for other
expenditures such as travel integral to the conduct of the project or costs for outside services performed, must
be clearly and fully documented in the project description in Section 3. Remember, not all committee members
are familiar with your area of study, and as such, they may not fully understand the need for materials, supplies,
travel, and other expenses. Such documentation must include:
• Name/description of expense item
• Cost of expense item
• Detailed justification for why this expense item is necessary
• Brief description of how this item is to be used for this project
• Can the project be completed without the requested item(s)?
3500
CREATIVE INQUIRY SUMMER EXPERIENCE (CISE) QEP GRANT FORM
Page 4
4. HEALTH and SAFETY
Consider your project from start to finish. What health and safety related issues are involved with the work you
will perform? What precautions will be taken to minimize the risks? Be sure to include information about
wastes generated, hazards present in the research project, environmental protection, and precautions to be taken
to protect yourself and others around you. (250 word maximum)
5. Ethics
Are there ethical considerations related to your project? (250 word maximum)
Ethics Signature Statement
By signing below, I (the student) certify that all information provided in this application is accurate and not
plagiarized. (Digital signature is preferable)
Student Signature Date
click to sign
signature
click to edit
CREATIVE INQUIRY SUMMER EXPERIENCE (CISE) QEP GRANT FORM
Page 5
6. Creative Inquiry Discussion of Your Project
If your project is Funded you must Present a 1 slide PowerPoint Presentation of your work
(~2-3 minutes) at the Annual Creative Inquiry Summer Experience Showcase event the first Tuesday or
Thursday in Fall Semester at 11:00 in Foster Hall Rm 233. Provide Slide to Dr. Lisic by Aug 21 by e-mail.
Discuss how you view your work and how it fits into our definition of “Creative Inquiry” below.
Our QEP is Creative Inquiry: The process of exploring issues, objects or works through the collection and
analysis of evidence including combining or synthesizing existing ideas, products, or expertise in original ways to
answer an open-ended question or achieve a desired goal.
Creative Inquiry Discussion NARRATIVE: 500 WORD MAXIMUM]
CREATIVE INQUIRY SUMMER EXPERIENCE (CISE) QEP GRANT FORM
Page 6
7. Project Description (there is no page limitation)
NOTE: This description must be written to an educated lay audience.
The review committee will not necessarily contain a member from your field.
The Project Description consists of the following sections:
I. Title
II. Abstract
III. Introduction/Background (include your main research question and/or creative outcome; use
supporting citations)
IV. Research or Project Plan (Describe what you plan to do during the course of the project)
V. Justification of Stipend and Budget: How will work hours be assessed by Faculty Mentor?
VI. Anticipated Results
VII. References
• Explain how the project extends both your own present knowledge and contributes to your
field of study; explain its value and to whom.
• Define the role of your faculty advisor: describe how you will collaborate, how often you
will meet, what, if any, direct responsibilities your advisor will have to the positive outcome
of the project.
INSERT PROJECT DESCRIPTION on additional pages
and then combine this whole proposal into a single PDF File for submission to edlisic@tntech.edu
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Completed 7 March 2020

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