Funding Period: January 1, 2017 to December 31, 2017

Interprofessional Education Grant

Funding Period: January 1, 2017 to December 31, 2017

IPEG Cover Sheet and Abstract

Grant Cover Sheet: A grant cover sheet including department chair signature and proposal abstract (500 word max) is required for review by the IPEG committee.

Project Title: Click here to enter text.
Investigator / Name
(First Last, Credentials) / Faculty Rank / Relevant Title / Department
Principle
Investigator (PI): / Click here to enter text. / Click here to enter text. / Click here to enter text. / Click here to enter text.
Co-PI (1) / Click here to enter text. / Click here to enter text. / Click here to enter text. / Click here to enter text.
Co-PI (2)
if applicable / Click here to enter text. / Click here to enter text. / Click here to enter text. / Click here to enter text.
Co-PI (3)
if applicable / Click here to enter text. / Click here to enter text. / Click here to enter text. / Click here to enter text.
Amount Requested: / Click here to enter text.
PI Signature: Click here to enter text.
Department Chair Name: Click here to enter text. / Signature: ______

Please select the IPE competencies and/or objectives to be addressed. Refer to the “Core Competencies for Collaborative Practice” developed by the Interprofessional Education Collaborative for details.

☐ Values/Ethics for Interprofessional Education / ☐ Roles/Responsibilities for Collaborative Practice
☐ Interprofessional Communication / ☐ Interprofessional Teamwork and Team-based Care

Resources Requested: (Select any resources you anticipate using)

Simulation Center Facility Support* / Simulation Resources*
☐ Task Training room / ☐ High Fidelity Mannequins
☐ Scenario suite / ☐ Standardized patients
☐ Debriefing rooms / ☐ Task Trainers--List: Click here to enter text.
☐ Exam Rooms
☐ Other--List: Click here to enter text. / ☐ Other--List: Click here to enter text.
* Requests for iCELS resources including scheduling time in the UMMS Standardized Patient program and Simulation Center is managed through the iCELS resource reservation system and UMMS room reservations.

Abstract (up to 500 Words): Click here to enter text.

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