APPLICATION FOR CWN SUPPORT

for National Research Team and Proposal Development

Intersectoral prevention strategies to address impacts of hydraulic fracturing on Aboriginal communities

Submission deadline: September 9, 2015

Instructions
Please complete this form as your application for CWN support. All fields must be completed and submitted no later than September 9, 2015 11:59pm (midnight) Eastern DaylightTime.
This is not a request for proposals. The intent of the current call for applications is to identify a strong national team with a strong concept that CWN can support in developing a proposal to CIHR and assist in attracting additional partner contributions. The successful team will be notified by CWN no later than September 16, 2015.
When complete, the application formshould be no longer than 7 pages, including tables and images.Please use a minimum of 11-point font.
Text box fields allow tables and images to be inserted. The text boxes on the form pages can be completed by copying from another text document (using the ‘Ctrl’ and ‘v’ keys). Please make liberal use of line spaces and capitals to make the text easier to read. You will not be penalized for using white space.
You may contact CWN for assistance:
  • If you require technical help with this form, contact Janice Levangie at 519-888-4567 ext. 39354.
  • If you have questions about the desired content of the application, please contact Katrina Hitchmanat 519-888-4567 ext. 37943.

  1. Nominated principal applicant information

Provide the following details for the individual acting as the team lead and key point of contactfor this application.
Last name: / First name:
Title:
Department:
Institution:
Telephone: / Fax: / Email:
Street address:
City: / Province: / Postal code:
  1. Proposal concept

Provide a high level overview of the approach your team would take to respond to the CIHR funding opportunity within the framework provided by CWN. That is, how would your team assess the suitability of current regulations, policies, and systems to prevent health impacts of hydraulic fracturing activities in Aboriginal communities? How would you design a project comprising studies and comparative assessments to provide concrete value by directly informing policy and practice decisions with a demonstrable expectation of improved prevention of negative health outcomes?
(Maximum 750 words)
  1. Project team

Describe the members of the proposed project team (including extended project partnerships) and indicate each team member’s anticipated role in the project.
Please distinguish between the independent researchersfor whom you would seek CIHR funding and knowledge users,other researchers, and partners who would provide input but would be supported through “leveraged” or in-kind funding from other sources. To indicate overall capacity, you may list separately those likely to contribute to the projects in anadvisory capacity.
Please indicate clearly which principal applicant will be the designatedTraditional Knowledge Keeper/Elder for the team.
Briefly list each team member’s area of expertise and outline their research excellence, qualifications and experience for their proposed role in the project.
If additional rows are needed please contact Janice Levangie at .
(Maximum 1.5 pages)
*For more details on CIHR’s team composition eligibility requirements, refer to the CIHR Team Grant: Environments and Health: Intersectoral Prevention Research funding opportunity website.
Independent researchers (supported by CIHR funding)
Name / Academic institution / Project role / Area of expertise/qualifications
*Nominated principal applicant
*Principal applicant
Knowledge users, other researchers, and partners (supported by other leveraged or in-kind funding)
Name / Organization / Project role / Area of expertise
* Knowledge user and principal applicant
*Knowledge user and co-applicant
*Knowledge user and co-applicant
Others taking part in the project in an advisory capacity
Name / Organization / Project role / Area of expertise
4. Team composition and structure
Describe how the proposed team’s research excellence, establishedcompetence, and experience are well suited to address the issues adequately and achieve improved prevention of negative health outcomes. In particular, highlight:
  • How the team’s interdisciplinary, multi-institutional, intersectoral, and cross-regional makeup is well suited to address the issues.
  • The team’s experience and familiarity with relevant practices, regulations, policies, and systems, and how the issues to be examined relate to these practices, regulations, policies, and systems.
(Maximum 750 words)
5. Existing relationships with Aboriginal communities
Describe the team’s existing relationships with Aboriginal communities located across Canada for whom impacts of hydraulic fracturing on health are an important issue. Describe any demonstrated interest in your proposed project from Aboriginalorganizations and groups, especially Aboriginal communities, including proposed partners.
(Maximum 400 words)
6. Additional expertise required
As appropriate, CWN may provide assistance to the successful team in connecting with additional expertise required by the research topic.If assistance is required, briefly indicate what type of expertise the team would benefit from adding, and what role this additional expertise would play in the proposed project.
(Maximum 250 words)

Page 1 of 4Application for CWN support – Intersectoral prevention research