APPLICATION FOR RESEARCH SEED GRANTS

Final Submission Deadline: Friday, Octboer 6, 2017 by 4:00 p.m.

Directions: ALL of the information requested must be supplied. Electronic submission is required (in one, collated pdf file) and must be sent to Kristi Katcher, at kkatcher@siumed.edu.

PRINCIPAL INVESTIGATOR:

Typed Name:	Signature:	Chair’s Signature:

DEPARTMENT:	% of time devoted to this project:

MAIL CODE & PHONE NUMBER (if Springfield or COMPLETE ADDRESS IF CARBONDALE/DECATUR/QUINCY):

TITLE OF PROJECT/PROPOSAL:

CO-INVESTIGATORS:	DEPARTMENTS:	CHAIR’S SIGNATURE

A.
B.

TOTAL BUDGET AMOUNT REQUESTED:

All Applicants:

By submitting this proposal, the PI agrees to provide grant proposal reviews at the request of the GRC chair for the next two (2) years (not to exceed 2 proposals per calendar year).

You have the option of naming one person to exclude as a reviewer from your application. Please check the box below if you would like to exercise this option. If “yes” is checked, Kristi Katcher will contact you prior to the making of reviewer assignments.

YES	NO

9/6/17, Form A