Research Promotion Fund Application

Research Promotion Fund

Request for funds must be submitted and approved in advance.


 

Principal Investigator:* 
Amount Requested: * 
Description and Purpose of Project: *

  1. Expenses, not to exceed $5,000, for principal investigator, coordinator, student or research team member travel to meetings within our outside the United States to present research conducted in the past or currently ongoing at Genesis.
         Presentation Topic:
         Destination:
         Expenses:
         Meeting:
  1. Stipend ($2,000 per student) for research students to conduct Genesis research studies.
         No. of students requested:
         Research Topic:
  1. Preparation of posters and slides for presentations related to research conducted at Genesis.
         Study/Topic
  1. Expenses for Professional publications (e.g. books and software) necessary to conduct research at Genesis, not to exceed $1,000 per year per investigator.
         Item Requested:
  1. Expenses for journal subscriptions and professional society memberships for researchers, not to exceed $2,000 per year per investigator.
         Item Requested:
  1. Expenses for editing required by professional journal or other publication.
         Amount Requested:
  1. Unfunded Research - An investigator may request funds to support unfunded research, not to exceed $10,000 per study. Approval of the request is dependent on the availability of funds. No funds will be approved for internal research until the IRB and the appropriate Administrator has approved the study. The funds can be used to cover the cost of start-up expenses for a new study and the expense of research staff.
         Study/Topic Concept:
         Anticipated Expenses:
  1. Reimbursement funds for continuing education programs for up to 3 coordinators per year per entity.
         Conference Name:
         Conference Location:
         Date of Conference:

Signature of Principal Investigator:
(This typed name serves as my official signature)
Date:
Contact Person:
Telephone Number:
Disbursement Information:  Mail Check    Pick-up Check
Address:
Decisions regarding disbursement of funds will be made by the Research Promotion Fund Committee. The Committee will do it's best to make decisions regarding funding requests within one week of request.
 
Please type the code shown in the image:

© 2012 Genesis Health System - All rights reserved.

1227 E. Rusholme Street Davenport, IA 52803 563-421-1000