Dr. Barry Adams Paediatric Resident Advocacy Education Grant

APPLICANT INFORMATION
Name Name First Last
Membership Number
Phone Phone - ### - ### ####
Email
Institution
Training
Training Year
If fellowship or 4th year, please specify specialty
Please provide a narrative biographical sketch of applicant
Please list all members of the project team.
PROGRAM INFORMATION
Program Director or project supervisor: name and title
Institution
Phone# of supervisor Phone# of supervisor - ### - ### ####
Email of supervisor
PROJECT INFORMATION
Please answer the following questions (maximum 300 words per question):
Project Title
Project summary: What is the project's main focus or area of interest?
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Describe the target community/population for this project/program.
Maximum of 300 words allowed. Currently Entered: 0 words.
Clearly identify the impact and scope of the research or advocacy work.
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Goals: Outline the short-term goals of this project and how they will be measured.
Maximum of 300 words allowed. Currently Entered: 0 words.
Goals: Explain the long-term goals (beyond grant) of this project and how they will be measured.
Maximum of 300 words allowed. Currently Entered: 0 words.
Why should this grant be used to fund this project? (e.g., summarize and justify the need for funding)
Maximum of 300 words allowed. Currently Entered: 0 words.
Explain how the project will be sustained beyond the grant period.
COMMUNITY COLLABORATION
Identify any community partners, organizations or others that you plan to work with and what their role is for the project.
Maximum of 300 words allowed. Currently Entered: 0 words.
PROJECT BUDGET
Attach a table outlining the major project activities, with timelines.

Attach Files

Word, PDF, or Excel format
Attach the estimated budget for this project. Please include detailed line items and identify any other sources of funding and the amounts. Please clearly indicate the amount of funding you are requesting from Healthy Generations.

Attach Files
Attach Letter(s) of support. Letter(s) should be from a program director, the organization you are working with, or someone in a leadership position who can vouch for the project.

Attach Files

(word, pdf).
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Dr. Barry Adams Paediatric Resident Advocacy Education Grant

Dr. Barry Adams Paediatric Resident Advocacy Education Grant

APPLICANT INFORMATION

PROGRAM INFORMATION

PROJECT INFORMATION

Please answer the following questions (maximum 300 words per question):

COMMUNITY COLLABORATION

PROJECT BUDGET