Research Grant: Application Form

To apply for an Eta Omega Research Grant you must be a current member of the Eta Omega Chapter. Each member is entitles to a maximum of 2 awards in each category, and after that may only apply every 5 years.

Check on of the following categories for review and funding:

_____Level I Investigator, Principle Investigator is author of a research article in a peer review journal (maximum amount of grant $1.500)

_____Level II Investigator, all other investigators who do no meet criteria for Level I Investigator (maximum amount of grant $1,000)

Title of Research Proposal: ______________________________________________________

Principle Investigator:

          Member of Eta Omega: yes_____ no_____

          Address:___________________________________________

                     ____________________________________________

          Telephone Number: home __________ work___________ cell ___________

          E-Mail Address: ___________________________________

          Are you a student? yes _____ no _____ University Program:___________________

          List degrees held (degree, major, institution, year obtained):

          ________________________________________________________________

          Other funding applied for (this research)? yes ____ no ____ Amount _____

          Source(s) of possible additional funding  ____________________________

          Previous publication of research (attach Curriculum Vita)

Co-Investigator (if applicable)

          Member of Eta Omega: yes _____ no_____

          Address: _________________________________________

                       _________________________________________

         Telephone number: home __________ work __________ cell ___________

E-Mail address: ________________________________________________

If this proposal is funded, you agree to:

1.      assume responsibility for the scientific and ethical conduct of this project

2.      use the grant for the research project as described in the application and return any excess funds to the Treasurer of Eta Omega Chapter

3.      present the findings of the research at an Eta Omega Chapter meeting

4.      acknowledge the assistance of Eta Omega Chapter, Sigma Theta Tau International in any presentations or publications that result from this research

5.      complete a biographical sketch for publication in Sigma Theta Tau International publications

6.      notify Eta Omega of receiving additional funding

Principle Investigator:_______________________________ Date _______________

                             _______________________________

                                            signature

Co-Investigator (if applicable): ______________________ Date ________________

                             _______________________________

                                            signature

Project beginning date: ____________ Completion date: ______________________

Institutional Review Board Approval: obtained ___ pending ___ not applicable_____

Revised 1/09 cwp

           ____________________________________________________________

          Telephone number: home ___________ work ____________ cell _______

 E-Mail address: _______________________________________________

 If this proposal is funded, you agree to:

1.      assume responsibility for the scientific and ethical conduct of this project

2.      use the grant for the research project as described in the application and return any excess funds to the Treasurer of Eta Omega Chapter

3.      present the findings of the research at an Eta Omega Chapter meeting

4.      acknowledge the assistance of Eta Omega Chapter, Sigma Theta Tau International in any presentations or publications that result from this research

5.      complete a biographical sketch for publication in Sigma Theta Tau International publications

6.      notify Eta Omega of receiving additional funding

Principle Investigator:___________________________________ Date:_________

                             ____________________________________

                                                           signature

Co-Investigator (if applicable): __________________________ Date:__________

                            _____________________________________

                                                           signature

Project beginning date:_________ Completion date: ______________________

Institutional Review Board Approval: obtained _______ pending _______ not applicable_____

Revised 1/09 cwp