Award year
* must provide value
Please download the application instructions and document templates required for your submission. You will be prompted to upload your completed documents as part of your application.
APPLICANT CERTIFICATION AND AUTHORIZATION FORM: Only one applicant certification and authorization form is required per application. The form must be completed by the project's Principal Investigator (PI). The PI-completed form must be reviewed and signed by the PI's Research Administrator and Department Chair/Chief. Electronic signatures are acceptable, but must be attributable to a particular signee.
RESEARCH STRATEGY: Only one research strategy document is required per application.
BUDGET AND BUDGET JUSTIFICATION FORM: A completed budget and budget justification form is required for each project. If necessary, please generate two separate sets of budget and budget justification forms (one for the PI's institution and one for the CBO's). Please combine and upload both sets of documents as a single file.
BIOSKETCH INSTRUCTIONS AND SAMPLE: Please read the instructions carefully and then download the biosketch template to be completed by all key collaborators. This may or may not include all members of a research team.
BIOSKETCH TEMPLATE: A completed biosketch is required for the PI and the community-based organization's (CBO) lead collaborator. Biosketches of additional key personnel from any institution may be uploaded in the Additional Supporting Documents section.
If provided, all letters of support should be written by the project's PI's and/or CBO representative's Department Chairs, Division Chiefs, or other individuals in positions to commit that the applicants will have sufficient protected time in order to conduct the proposed study.
Document download section end
Project title
* must provide value
Project descriptionPlease provide an abstract or a brief description of your project (maximum 250 words).
* must provide value
Does the proposed project involve human participants?
For information, please see the NIH definition of a human subjects research at HumanSubjects.NIH.gov * must provide value
Yes No
Does your study meet the NIH definition of a clinical trial?
For more information, please see the NIH definition of a clinical trial at Grants.NIH.gov * must provide value
Yes No
Clinical trial phase
For information on the clinical trial phases, please visit the ClinicalTrials.gov * must provide value
Early Phase 1 Phase 1 Phase 1-2 Phase 2 Phase 2-3 Phase 3 Phase 4 Not sure
PLEASE NOTE: Tufts CTSI can only support clinical trial activity through the end of Phase IIB.
Project information section end
APPLICANT CERTIFICATION AND AUTHORIZATION FORM: Please upload the completed and signed applicant certification and authorization form as scanned PDF.
* must provide value
RESEARCH STRATEGY: Please upload the completed research strategy form.
* must provide value
BUDGET FORM(S): Please upload a completed set of budget and budget justification forms.
* must provide value
Project documents section end
Please note that all proposals must designate a PI who has a primary appointment or position at a Tufts CTSI academic or clinical institution. To see a list of eligible institutions, please visit the Tufts CTSI website . For questions or assistance, please reach out to the Community Health Catalyst Program Team at community@tuftsctsi.org . First name
* must provide value
Last name
* must provide value
Title or position
* must provide value
Degree(s)
* must provide value
Check all that apply
Degree(s), other
* must provide value
Primary affiliation
* must provide value
Baystate Medical Center Brandeis University Lahey Hospital and Medical Center Maine Medical Center Massachusetts Institute of Technology Massachusetts General Hospital Institute of Health Professions New England Baptist Hospital Newton-Wellesley Hospital Northeastern University RAND Corporation St. Elizabeth's Medical Center The Jackson Laboratory Tufts Medical Center Tufts University Other
Primary affiliation, other
* must provide value
School or center
* must provide value
Tufts University Sackler School of Graduate Biomedical Sciences Tufts University School of Engineering Tufts University Cummings School of Veterinary Medicine Tufts University Fletcher School of Law and Diplomacy Tufts University Friedman School of Nutrition Science and Policy Tufts University School of Dental Medicine Tufts University School of Arts and Sciences Tufts University Tisch College of Citizenship and Public Service Tufts University Jean Mayer USDA Human Nutrition Research Center on Aging Tufts University School of Medicine Tufts Center for the Study of Drug Development Other
School or center, other
* must provide value
DepartmentIf PI's organization does not have a department name, simply input N/A.
* must provide value
Student or trainee statusPlease specify PI's student or trainee status, if applicable.
* must provide value
Clinical Fellow Clinical Intern Clinical Resident Student T Awardee K Awardee Other Not applicable
Academic rankPlease specify PI's academic rank, if applicable.
* must provide value
Distinguished Professor Professor Associate Professor Assistant Professor Lecturer Instructor Adjunct Professor Clinical Associate Other Not Applicable
Email addressPlease provide email address associated with PI's primary affiliation.
* must provide value
Phone numberPlease provide phone number associated with PI's primary affiliation.
* must provide value
e.g., 617-636-5000
Business addressPlease provide mailing address associated with PI's primary affiliation.
* must provide value
e.g., 35 Kneeland Street, 11th Floor, Room 1107
City
* must provide value
State
* must provide value
Alabama Alaska Arizona Arkansas California Colorado Connecticut Washington D.C. Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming
Zip code
* must provide value
BIOSKETCH : Please upload PI's completed biosketch.
* must provide value
PRINCIPAL INVESTIGATOR section end
Please note that all proposals must designate a representative of a CBO with a tax exempt status obtained through the Internal Revenue Service (IRS). Non-Tufts CTSI-affiliated CBOs are eligible to apply. For questions or assistance, please reach out to the Community Health Catalyst Program Team at community@tuftsctsi.org . First name
* must provide value
Last name
* must provide value
Title or position
* must provide value
Primary affiliation
* must provide value
Action for Boston Community Development Asian Community Development Corporation Asian Task Force Against Domestic Violence Asian Women for Health Boston Chinatown Neighborhood Center Center for Information and Study on Clinical Research Participation Greater Boston Chinese Golden Age Center Health Resources in Action Museum of Science, Boston New England Quality Care Alliance Other
Primary affiliation, other
* must provide value
DepartmentIf collaborator's organization does not have a department name, simply input N/A.
* must provide value
Email addressPlease provide email address associated with collaborator's primary affiliation.
* must provide value
Phone numberPlease provide phone number associated with collaborator's primary affiliation.
* must provide value
e.g., 617-636-5000
Business addressPlease provide mailing address associated with collaborator's primary affiliation.
* must provide value
e.g., 35 Kneeland Street, 11th Floor, Room 1107
City
* must provide value
State
* must provide value
Alabama Alaska Arizona Arkansas California Colorado Connecticut Washington D.C. Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming
Zip code
* must provide value
BIOSKETCH : Please upload collaborator's completed biosketch.
* must provide value
Please indicate how many letters of support, additional biosketches, and/or other supporting documents you would like to upload.
None 1 2 3 4 5 6 7 8 9 10
DOCUMENT 1 : Please upload document 1 for review.
DOCUMENT 2 : Please upload document 2 for review.
DOCUMENT 3 : Please upload document 3 for review.
DOCUMENT 4 : Please upload document 4 for review.
DOCUMENT 5 : Please upload document 5 for review.
DOCUMENT 6 : Please upload document 6 for review.
DOCUMENT 7 : Please upload document 7 for review.
DOCUMENT 8 : Please upload document 8 for review.
DOCUMENT 9 : Please upload document 9 for review.
DOCUMENT 10 : Please upload document 10 for review.
Your responses to the next questions will be used to begin the collaborative project development and planning process only. They will not affect funding decision-making. You may be contacted by Tufts CTSI prior to the award announcement to discuss post-award procedures and requirements. For questions or assistance, please reach out to the Community Health Catalyst Program Team at community@tuftsctsi.org . Has the research team for this proposal - the PI and one or more representatives of the above-named partner CBO - previously worked together on a research project as investigators?
Yes No
Has the research team for this proposal - the PI and one or more representatives of the above-named partner CBO - previously worked together on a research project in capacities other than investigators (e.g., contributing as consultants, providing assistance with recruitment)?
Yes No
Does the proposed project currently have an Institutional Review Board (IRB) approval?
Yes No Pending Not sure
Does the partner CBO have a tax-exempt status (e.g., 501(c)(3) or other)?
Yes No Not sure
Does the partner CBO have a Data Universal Numbering System (DUNS) number?
Yes No Not sure
Does the partner CBO have a System for Award Administration (SAM) credentials?
Yes No Not sure
Does the partner CBO have an Electronic Research Administration (eRA) Commons username?
Yes No Not sure
Does the partner CBO have an established facilities and administration (F&A)/indirect cost (IDC) rate?
Yes No Not sure
Administrative logistics section end
I, (as PI), certify that the statements herein are true, complete, and accurate to the best of my knowledge. If a Community Health Catalyst Program funding is awarded, I agree to accept responsibility for scientific conduct of the project, providing the required progress and outcomes reports, and complying with the Tufts CTSI pre- and post-award requirements outlined in the Request for Applications. I also accept responsibility for payment of any and all over-expenditures should they occur as a result of this project. Citation Requirements Long-term Outcomes Tracking
Principal Investigator signature
* must provide value
Please type in your first name and last name.
Principal Investigator signature date
* must provide value
Today M-D-Y
Please review your information prior to final submission. If you are satisfied with your responses, please click "SUBMIT." You will have a chance to provide your email address to receive a confirmation email.
If you would like to save your progress and return to where you left off to complete the survey later (before the submission deadline), please click "SAVE AND RETURN LATER". Please provide your email address when prompted and save the return code that will be shown on the screen. You will receive an email with a link to return to your application, but the email will NOT contain the return code. Please note that if you lose or forget your return code, DO NOT click on the "Start Over" button, as this will erase all of your data. Instead, please email
community@tuftsctsi.org and we will help you return to your unfinished application.
Community Health Catalyst Program manager only! Please enter the total budget amount.
Submit
Save & Return Later
Working...