2017 Academic Community Collaboration Award (ACCA)

APPLICATION INSTRUCTIONS

Please use this application template with 1-inch margins, single-spaced,Times New Roman font, size 11. Please see the Request for Proposals for content considerations and tips.

Instructions for completing the 2017 Academic Community Collaboration Award Application are as follows (*Indicates required field.)

Letter of Intent (LOI):

Letters of Intent should be one page, and should include:

  • Name(s) of GW-based key research personnel
  • Name of community partner organization, and the name(s) and title(s) of key personnel
  • Title of your proposal

A Letter of Intent must be submitted by Monday, August 7, 2017, by 5:00PM. All partnerships who submit a LOI will be eligible to submit their Full Proposal. Proposals that have not been preceded by an LOI will not be considered.

Proposal:

1. Cover Pageincluding:

A.Project title, name andsignaturesof primary GWU and Community Partner.

B. Suggested Period of Performance:Provide the project Start Date and the project End Date. The earliest start date is December 1, 2017.

C. Requested Budget:Providethe total funding requested for this project from the Rodham Institute

D. Institutional Review Board (IRB):Indicate whether this project will require IRB approval. For research studies, IRB approval of human subjects is not required prior to review of an application; however, proof of IRB approval will be required prior to the initiation of the research study. The Rodham Institute can assist groups with guidance as per IRB if awarded.

2. Collaboration Information Pageincluding:

A. Primary Faculty/Student Partner Information:Provide complete contact information and a brief biosketch for all participating faculty and students.

B. Primary Community Partner Information: Provide complete contact information and a brief biosketch for all participating community partners.

3. Abstract Page:Provide project abstract (brief summary of project). Abstracts should not exceed 200 words.

4. Project Narrative:This should not exceed three pages. The requested format of the application is as follows:

  1. Introduction(Describe the local health disparity relevant to your project)
  2. Specific Aims(Clearly define your objectives)
  3. Methods(Ensure that your methods are feasible given your reported budget)
  4. Evaluation Plan(Detail how you will evaluate your outcomes and how will evaluate potential local impacts on local health equity)
  5. Dissemination Plan(Detail plan for sharing research findings and/or highlighting program successes and lessons learned with academic and community audiences)
  6. Significance(Indicate the implications for programs or policy as well as how the proposed work will lead to further activities and future funding)

5. Budget Form:Please use the Budget Template.Include direct costs only. Direct costs are those costs that can be identified specifically with the project.Indirect costs are not permitted.

  • Personnel: Salary support for community partners’ staff and students should be listed in the Personnel section. Enter the first and last name of each person requesting salary support. No salary support for faculty permitted.
  • Consultant Costs:Itemize and enter the estimated funds for consultants. Funding for community collaborators should be listed in Consultant Costs.
  • Supplies, Travel, and Other Expenses: Itemize and enter the estimated funds required for each field as applicable.
  • Total Requested Funds:* Enter the total costs. This number should match the requested budget from above.
  • Budget Justification: Provide a narrative that explains the amounts requested for each line in the budget. This should not exceed one page.The budget justification should specifically describe how each item will support the achievement of proposed objectives. The budget justification must clearly describe each cost element and explain how each cost contributes to meeting the project’s objectives/ goals.
  • List all additional funding sources for this project: If any part of this project is currently funded or is pending funding by another source, list the funding organization, total support amount, and dates of support.
  • Biographical Sketches of University and Community Partners: Include biographical sketches for all persons contributing to the project; at least two biographical sketches must be attached (one for the community partner and one for the university partner). Each biographical sketch should be one page or less and include: name, current contact information, and professional experience

ALL LOIs MUST BE SUBMITTED as a single PDF document VIA EMAIL by August 7, 2017 by5:00PM.

ALL PROPOSALS MUST BE SUBMITTED as a single PDF document VIA EMAIL bySeptember 5, 2016 by5:00PM.