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Awards & Grants


Resident Advocacy Grant

Application Form

Before proceeding with this application, please make sure to review the guidelines. Please have all required attachments ready (see sections 3 and 5)

Membership Number:
SECTION 1 - APPLICANT DATA
Salutation:       
First Name:     Last Name: 
Address:
City:
Province:
Postal Code:

Tel:    ext.
Fax:
E-mail:
Training:        Training Year: 
If fellowship or 4th year, please specify specialty: 
Narrative biographical sketch of applicant (max 300 word; CVs will not be accepted):
Describe the applicant's responsibilities in carrying out this project? 
SECTION 2 - PROGRAM INFORMATION
Program Director's Information:
First Name:           Last Name:  
Institution:           Department: 
Address:
City:
Province:
Postal Code:
Tel:      ext.
Fax:
E-mail
SECTION 3 - PROJECT INFORMATION
Project Title:     
Indicate the project's main focus or area of interest:   
Please describe the target community/population for this project/program:
Is this an existing project/program?       Yes       No
If yes, describe what project related activities have been carried out to date:
Project abstract
Provide a summary of the project, describing the project and clearly identifying the impact and scope of the research or advocacy work (max 300 words)
The short term goals (life of grant) of this project are to:
The long term goals (beyond grant) of this project are to:
Why should this grant be used to fund this project (e.g., summarize and justify the need for funding)?
How will you assess the achievement of your project short term goals?
Please attach table outlining the major project activities, with timelines incorporated. The table should have three columns: column 1 - Project activity, column 2 - From (month), column 3 - To (month) (word document format)
SECTION 4 - COMMUNITY COLLABORATION
Identify current community partners for this project.
Identify any individuals, groups or organizations that you plan to work with during this project.
Describe any project related activities that have been carried out to date (e.g., community meetings, proposals submitted, etc.)
SECTION 5 - PROJECT BUDGET
Identify sources of PAST, CURRENT and possible FUTURE funding:
How do you plan to sustain this project beyond the grant period?
Please attach the estimated budget for this project (see Guidelines for Developing your Budget for details) (word document format)
SECTION 6 - ADDITIONAL BACKGROUND INFORMATION (If required)
 
Up to four pages of additional information may be attached if required (word document format)

 

 
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