Massage Therapy Research Fund (MTRF)
Partnership of
/ APPLICATION FORM

SECTION 1 –GENERAL INFORMATION

Instructions: Complete information for Section 1 on this document

1.1 / Project Title:
1.2 / Principal Applicant(s)
Provide the following information for all principal applicant(s)
Name:
Mailing Address:
E-mail:
Phone:
Fax:
1.3 / Co-applicants’
Complete the following information for all co-applicant(s):
Add 1 row for each co-applicant
Name:
Institutional affiliation:
1.4 / Is this project a thesis or dissertation project? (circle one): YES NO
If yes, provide the following information:
Student’s name:
Degree being sought:
Supervisor’s name:
1.5 / Applicant’s Institution:
Institution name:
Address:
Name of Grant Administrator:
Contact for Grant Administrator (email preferred):
Institution name:

SECTION 2 – PROJECT INFORMATION

Instructions: With the exception of Section 2.3, 2.9 and 2.10, provide the information for section 2 on this form.

2.1 / Ethics Approval
Has this project received ethical approval? (circle one): YES NO
If yes, please submit a copy of the ethics approval as part of the application package.
If ethics approval for the proposed project is note being sought, please provide a brief rationale or letter from the ethics office:
Please note: funds will not be released until information regarding ethical approval is obtained.
2.2 / Research Priorities
Briefly identify how the proposed project fits in with at least one of the MTRF research areas (see Guidelines). Maximum words: 250.
2.3 / Project Proposal
Provide a description of the proposed study.Use 12 point font size and Times New Roman font. The text may be single or double spaced. The following sections must be included:
  • Background
  • Rationale
  • Objective(s)/research question(s)
  • Research Design and Methodology, including analysis plan
  • Significance of the study
Maximum word count: 2000.
Instructions: Submit your PROJECT PROPOSAL as a separate word document (.doc or .docx formats requested). Provide the section title, the principal investigator’s name, and page number in the header of the document.
2.4 / Description of Massage Therapy Intervention
Provide a detailed description of the Massage Therapy intervention that will be investigated through the proposed study. Maximum word count: 300 words.
2.5 / Information Dissemination Plan
Provide a brief outline of how the research results will be disseminated. Maximum wordcount: 250.
2.6 / Estimated Budget
The total amount of funding requested: $______
Please provide a detailed outline of the proposed budget and requested funds, including a cost break down per item. Maximum: 1 page
2.7 / Lay Summary
Provide a brief lay-word summary of the proposed project suitable for a press release. Maximum word count: 75.
2.8 / Practice Implications
Provide a clear statement of practice implications of the proposed study in relation to:
  • Practice of massage therapists
  • Massage therapy education
  • Policies related to MT
Maximum word count: 300 words
2.9 / Additional Information (required)
  • Reference list
  • Short curriculum vitae (maximum: 4 pages) for each of the applicants
Instructions: Submit as separate word files (.doc or .docx formats only)
2.10 / Additional Information (optional)
Indicate below the supporting documents that are being submitted as part of the application package:
  • Questionnaire
  • Interview guide
  • Outcome measure(s)
  • Other: (please list):
  • ______
  • ______
  • ______
Instructions: Submit these items as separate files.

SECTION 3: SIGNATURE SHEET

Instructions: For the application to be considered complete,all individuals identified in Section 1 must be indicated and provide original signatures. Add lines as needed. In addition, the name and signature of the Department or Division Head of the sponsoring institution must be provided.

______

Name of Principal ApplicantSignatureDate

______

Name of Co-applicantSignatureDate

______

Name of Co-applicantSignatureDate

______

Name of Co-applicantSignatureDate

______

Name of Co-applicantSignatureDate

______

Name of student’s SupervisorSignatureDate

(if applicable)

______

Name of Department or Signature Date

Division Head

For office use ONLY
Date application package was received in the office: ______
Received by:______
1 / MTRF Funding Competition –2014/15 – APPLICATION FORM