Fillable Team Grant Application 1 URECA! TEAM-GRANT APPLICATION FORM -TTU

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Team Grant Application 1 URECA! TEAM-GRANT APPLICATION FORM -TTU

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The Team Grant Application 1 URECA! TEAM-GRANT APPLICATION FORM -TTU form is 8 pages long and contains:

  • 5 signatures
  • 24 check-boxes
  • 108 other fields

Country of origin: US
File type: PDF

U.S.A. forms for Tennessee Technological University

BROWSE TENNESSEE TECHNOLOGICAL UNIVERSITY FORMS

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URECA! TEAM-GRANT APPLICATION FORM -TTU
Page 1
1. COVER PAGE
Project Title:
Project Begin Date: Project End Date:
(MM/DD/YYYY) (MM/DD/YYYY)
STUDENT INFORMATION (as of today’s date):
Student ID T# TTU Email Address GPA:
Name:
Name:
Name:
Name:
Faculty Mentor:
Faculty Mentor:
BUDGET SUMMARY : (food is not allowed)
SUPPLIES
Stipend
Travel
OTHER
TOTAL
(requested from grant)
SIGNATURES:
________________________________________
(STUDENT) (DATE)
________________________________________
(STUDENT) (DATE)
________________________________________
(STUDENT) (DATE)
________________________________________
(STUDENT) (DATE)
________________________________________
(FACULTY Mentor) (DATE)
________________________________________
(FACULTY Mentor) (DATE)
URECA! TEAM-GRANT APPLICATION FORM -TTU
Page 2
2. URECA! BUDGET FORM (To be developed in consultation with faculty mentor)
Project Title:
DETAILED BUDGET:
Itemize expenses for items not provided through TTU or your faculty mentor. The maximum is $1000 for
academic year mini-grants. Submit separate sheet 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 $5000 maximum of this
award, then list any other sources of support (SMAC 606, other grants) on a separate additional sheet.
Expense Items
Estimated Costs
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
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. 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)?
URECA! TEAM-GRANT APPLICATION FORM -TTU
Page 3
3. PROJECT DESCRIPTION: This section is most important, and can be prepared on additional pages. There
are no page limitations, but be efficient and concise, an overly long proposal doesn’t help the reviewers.
The Project Description consists of the following sections:
• Introduction/Background (include your main research question and/or creative outcome; use
supporting citations)
• Proposed plan, with preliminary results if possible.
• TEAM Roles. Define the role of the faculty advisor(s), and the role of every team member:
• Budget justification.
• Dissemination of results. Explain how the project extends present knowledge and contributes to the
students field of study; explain its value and to whom (will students present the research (where?) or try
to publish?).
NOTE: This description must be written to an educated lay audience.
The review committee will not necessarily contain a member from your field.
Project ABSTRACT:
Project Description with additional pages will follow on the next pages:
URECA! TEAM-GRANT APPLICATION FORM -TTU
Page 4
4. Environmental Health and Safety (check all that apply to your proposed research)
Infectious Agents (including Select Agents)
Human Derived Materials
Recombinant DNA
Hazardous Chemicals (including controlled substances)
Will hazardous wastes be generated?
Yes
No
Plant Pathogens (including Select Agents)
Compressed gases
Cryogenic materials
Noise
Nanoparticles
Non-native/Invasive species
Shipping/receiving and/or transporting hazardous materials (including dry ice, chemicals, and biological
materials)
Radionucleotides
Ionizing radiation/Lasers
Aquatic hazards (diving/boat/etc.)
If any box above is checked your application may also be reviewed by Environmental Health and Safety. For
guidance in defining research hazards, please consult the EHS website: www.tntech.edu/safety
Vertebrate Animals
http://www.tntech.edu/research/animal-care-and-use-iacuc/
1. Does the research proposed in this application involve the use of vertebrate animals?
No. (Review by IACUC is NOT required. Do not answer Question 2.)
Yes. (Review by IACUC is required. Continue with Question 2.)
2. A protocol for the research proposed in this application (check one):
has been approved and is on file in the IACUC.
has been submitted to the IACUC.
will be submitted to the IACUC.
URECA! TEAM-GRANT APPLICATION FORM -TTU
Page 5
Human Subjects
http://www.tntech.edu/research/hs-guidelines/
1. Does the research proposed in this application involve the use of human subjects (INCLUDING use of
de-identified data or specimens of human origin)?
No. (Review by the TTU Institutional Review Board is NOT required. Do not answer Question 2
in Safety Training.)
Yes. (Review by TTU Institutional Review Board is required. Continue with Question 2 in Safety
Training.)
Include in the URECA! application your IACUC and/or IRB application(s) and/or approval letter(s).
Note: No funding will be given prior to the receipt of the necessary approval, but applications will still be
accepted.
Safety Training
1. Have students completed all appropriate required TTU safety training?
Yes (Answer question 2)
No
2. Which TTU safety training(s) have been completed? List training title and date of completion. Note:
TTU safety training(s) are required prior to the start of any project. These pages can be appended to the
end of this proposal.
URECA! TEAM-GRANT APPLICATION FORM -TTU
Page 6
5. HEALTH and SAFETY
Consider your project from start to finish. What health and safety related issues are involved with the work
students 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)
[INSERT HEALTH/SAFETY/ETHICS STATEMENT for the TEAM: 250 WORD MAXIMUM]
6. Ethics for the TEAM
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.
Student Signature Date
Student Signature Date
Student Signature Date
Student Signature Date
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URECA! TEAM-GRANT APPLICATION FORM -TTU
Page 7
7. LEARNING OBJECTIVES AND CAREER NARRATIVE:
Describe what you will learn, skills you will develop, and/or techniques that you will use and how this will
enhance your career goals. This should be addressed by every undergraduate researcher, but they can be
combined.
[INSERT OBJECTIVES AND CAREER NARRATIVE: 500 WORD MAXIMUM]
URECA! TEAM-GRANT APPLICATION FORM -TTU
Page 8
8. FACULTY MENTOR’S SUPPORT FORM (if more than one faculty, each have to submit this form)
To be completed by faculty mentor. Must be signed and included with application.
Application Information:
Students Name:
Project Title:
Faculty Mentor Information:
Name: Rank:
College/School : Department:
Telephone: Campus Box:
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
Have the Students taken all required safety courses? Yes No
Faculty Mentor Endorsement:
Please complete the following Faculty Mentor Endorsement form describing the merit of the
project and its potential impact on the student, the student’s potential for successful completion, and your role in the project. Your
comments are very influential in the committee’s decision. Please Type.
1) Please provide comments on the merit of this project and its potential impact on the student’s engagement in
research, scholarship, and/or creative activity.
2) Please comment on the student’s potential for successfully completing the project.
3) Please comment on your role in this project.
Mentor Signature Date
My department chair is aware of this project and is supportive of the project and my involvement as a faculty mentor.
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Team Grant Application 1 URECA TEAM-GRANT APPLICATION FORM -TTU

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Completed 8 March 2020

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