Award year
* must provide value
PROPOSAL TEMPLATE:
Please download the document template required for your submission. You will be prompted to upload your completed document as part of your application. When you click on the link to download the template, you will be asked "Do you want to leave this site? Changes you made may not be saved." Please select LEAVE. Do not worry, your online application will not be affected. Alternatively, you can right-click on the link and select "open in new tab."
LETTER OF SUPPORT/COMMITTMENT :
A letter of support/commitment should be written by investigator's Department Chair or Division Chief, or other individual in a position to commit that the applicant will have sufficient protected time in order to conduct the proposed study.
The letter should be prepared on appropriate departmental/divisional letterhead and be no more than two pages in lenght. In addition to the protected time commitment, should also describe any other departmental/divisional resources to be provided that are necessary to the successful conduct of the study, outside those to be provided by the Tufts CTSI Informatics Team.
Document download section end
Project title
* must provide value
Project description
Please provide an abstract or brief description of your project (maximum 250 words)
* must provide value
PROPOSAL:
* must provide value
LETTER OF SUPPORT/COMMITTMENT:
* must provide value
RESEARCH PROTOCOL:
Optional
Project information section end
Title or position
* must provide value
First name
* must provide value
Last name
* must provide value
Degree(s)
* must provide value
Check all graduate degrees that apply
Degree(s), other
* must provide value
Primary affiliation
* must provide value
Lowell General Hospital MelroseWakefield Hospital Tufts Medical Center
Department or division
* must provide value
Academic rank
Please specify your academic rank, if applicable.
* must provide value
Distinguished Professor/Distinguished Clinical Professor Professor/Clinical Professor Associate Professor/Clinical Associate Professor Assistant Professor/Clinical Assistant Professor Lecturer Instructor Adjunct Professor Other Not Applicable
Academic rank, other
* must provide value
Email address
Please provide email address associated with your primary affiliation.
* must provide value
Phone number
Please provide phone number associated with your primary affiliation.
* must provide value
Number of senior/key collaborators
* must provide value
0 1 2 3
COLLABORATOR 1 INFORMATION Collaborator's role on the project
* must provide value
Co-Principal Investigator Co-Investigator Advisor/consultant Other
Collaborator's role, other
* must provide value
Collaborator's first name
* must provide value
Collaborator's last name
* must provide value
Collaborator's degree(s)
* must provide value
Check all graduate degrees that apply
Collaborator's degree(s), other
* must provide value
Collaborator's primary affiliation
* must provide value
Asian Community Development Corporation Asian Task Force Against Domestic Violence Asian Women for Health Authentic Caribbean Foundation Boston Chinatown Neighborhood Center Brandeis University Center for Information and Study on Clinical Research Participation Cooperative Services Inc. Support & Development Critical Path Institute Greater Boston Chinese Golden Age Center Greater Boston Section of the National Council of Negro Women Kaiser Permanente Center for Health Research Institute for Clinical Research and Health Policy Studies Lahey Hospital and Medical Center Maine Medical Center Massachusetts Biotechnology Education Foundation Massachusetts General Hospital Institute of Health Professions Massachusetts Institute of Technology Museum of Science, Boston Newton-Wellesley Hospital Northeastern University Point32Health RAND Corporation The Jackson Laboratory Tufts Medical Center/Tufts Medicine Tufts University Urban College of Boston Other
Collaborator's primary affiliation, other
* must provide value
Collaborator's 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
Collaborator's school or center, other
* must provide value
Department or division
* must provide value
If your collaborator's organization does not have a department, simply input n/a.
Collaborator's academic rank
* must provide value
Distinguished Professor Professor Associate Professor Assistant Professor Lecturer Instructor Adjunct Professor Clinical Associate Other Not Applicable
Collaborator's email address
* must provide value
COLLABORATOR 2 INFORMATION Collaborator's role on the project
* must provide value
Co-Principal Investigator Co-Investigator Advisor/consultant Other
Collaborator's role, other
* must provide value
Collaborator's first name
* must provide value
Collaborator's last name
* must provide value
Collaborator's degree(s)
* must provide value
Check all graduate degrees that apply
Collaborator's degree(s), other
* must provide value
Collaborator's primary affiliation
* must provide value
Asian Community Development Corporation Asian Task Force Against Domestic Violence Asian Women for Health Authentic Caribbean Foundation Boston Chinatown Neighborhood Center Brandeis University Center for Information and Study on Clinical Research Participation Cooperative Services Inc. Support & Development Critical Path Institute Greater Boston Chinese Golden Age Center Greater Boston Section of the National Council of Negro Women Kaiser Permanente Center for Health Research Institute for Clinical Research and Health Policy Studies Lahey Hospital and Medical Center Maine Medical Center Massachusetts Biotechnology Education Foundation Massachusetts General Hospital Institute of Health Professions Massachusetts Institute of Technology Museum of Science, Boston Newton-Wellesley Hospital Northeastern University Point32Health RAND Corporation The Jackson Laboratory Tufts Medical Center/Tufts Medicine Tufts University Urban College of Boston Other
Collaborator's primary affiliation, other
* must provide value
Collaborator's 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
Collaborator's school or center, other
* must provide value
Department or division
* must provide value
If your collaborator's organization does not have a department, simply input n/a.
Collaborator's academic rank
* must provide value
Distinguished Professor Professor Associate Professor Assistant Professor Lecturer Instructor Adjunct Professor Clinical Associate Other Not Applicable
Collaborator's email address
* must provide value
COLLABORATOR 3 INFORMATION Collaborator's role on the project
* must provide value
Co-Principal Investigator Co-Investigator Advisor/consultant Other
Collaborator's role, other
* must provide value
Collaborator's first name
* must provide value
Collaborator's last name
* must provide value
Collaborator's degree(s)
* must provide value
Check all graduate degrees that apply
Collaborator's degree(s), other
* must provide value
Collaborator's primary affiliation
* must provide value
Asian Community Development Corporation Asian Task Force Against Domestic Violence Asian Women for Health Authentic Caribbean Foundation Boston Chinatown Neighborhood Center Brandeis University Center for Information and Study on Clinical Research Participation Cooperative Services Inc. Support & Development Critical Path Institute Greater Boston Chinese Golden Age Center Greater Boston Section of the National Council of Negro Women Kaiser Permanente Center for Health Research Institute for Clinical Research and Health Policy Studies Lahey Hospital and Medical Center Maine Medical Center Massachusetts Biotechnology Education Foundation Massachusetts General Hospital Institute of Health Professions Massachusetts Institute of Technology Museum of Science, Boston Newton-Wellesley Hospital Northeastern University Point32Health RAND Corporation The Jackson Laboratory Tufts Medical Center/Tufts Medicine Tufts University Urban College of Boston Other
Collaborator's primary affiliation, other
* must provide value
Collaborator's 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
Collaborator's school or center, other
* must provide value
Department or division
* must provide value
If your collaborator's organization does not have a department, simply input n/a.
Collaborator's academic rank
* must provide value
Distinguished Professor Professor Associate Professor Assistant Professor Lecturer Instructor Adjunct Professor Clinical Associate Other Not Applicable
Collaborator's email adrdress
* must provide value
Collaborator information section end
APPLICANT CERTIFICATION AND AUTHORIZATION
* must provide value
I, (as PI), certify that the statements herein are true, complete, and accurate to the best of my knowledge. If an Informatics voucher is awarded, I agree to accept responsibility for scientific conduct of the project, provide the required outcomes reporting, and comply with the Tufts CTSI terms and conditions 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: Any publication, poster, or presentation resulting from this research project will cite the Tufts CTSI award UM1TR004398 and comply with the NIH Public Access Policy.Long-term Outcomes Tracking Awardees are required to report study progress and outcomes annually using a Tufts CTSI-provided online tool for at least five (5) years after the funding ends. Outcomes to be reported include professional presentations, published manuscripts, subsequent funding applications and awards, research products and associated intellectual property protections, and activities to implement findings into clinical care or public health.
Principal investigator's signature
* must provide value
Please type in your first name and last name.
Principal investigator's 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 application later, 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
voucher@tuftsctsi.org and we will help you return to your unfinished application.
Submitted Under review Reviewed Awarded Not awarded
For Tufts CTSI office use only
For Tufts CTSI office use only
Submit
Save & Return Later