Application Form and Check List

We understand that you are in the very beginning / planning stages of your project. We would like to learn more about the things your team is coming together to do. Please fill out the form provided below in addition to the other requested materials and send your completed application package to Sherri Pooyak sherrip@caan.ca.

Proposal attachment guidelines:

Attachments must be submitted in a PDF file. Use a font size of 12-point, black type. Six lines per inch. No condensed

type or spacing. Use only letter size (21.25 X 27.5 cm / 8.5" X 11") white paper/background

for all attachments. Observe page limitations, additional pages may NOT be added unless

specified.

APPLICANT INFORMATION

Principal Applicant: The Principal Applicant must be based in Canada and acts as the primary contact for the proposed research team. AIDS Service Organization (ASO) staff, staff at community-based organizations, Graduate students, postdoctoral fellows, research associates and technical support staff are eligible to be a Principal Applicant.Name:Position/role at institution:Agency/Affiliation (as applicable):Mailing Address (building, street, city, postal code):

Phone: Fax: E-Mail:

1. Additional Applicant contact informationProvide the following:Team member names, addresses and affiliations, signature and a brief (100 word) bio of up to three (3) Team Members included in the proposal.Team Member must provide a signature (electronic signatures are acceptable) to acknowledge that they are aware of and agree to contribute to the completion of this research project.Name:

Position/role:

Agency/Affiliation (as applicable):Mailing Address (building, street, city, postal code):

Phone: Fax: E-Mail:

Applicant Signature:

2. Additional Applicant contact information (attach a list on an additional page if there are more than 3 additional applicants)Name:

Position/role:

Agency/Affiliation (as applicable):Phone: Fax: E-Mail:

Applicant Signature:

3. Additional Applicant contact information (attach a list on an additional page if there are more than 3 additional applicants)Name:

Position/role:

Agency/Affiliation (as applicable):Phone: Fax: E-Mail:

Applicant Signature:

PROJECT INFORMATION

Project Title:

Community where proposal development is being undertaken:

Total Funding Requested:

Amount of anticipated in-kind support (if any):

Total requested cost of project:

Anticipated Project Start Date:

Anticipated Project Completion Date:

Project Description: Attach a two (2) page (not including references and appendices) proposal with this application and label it: “Attachment A – Full Proposal”.Your 2-page Full Proposal attachment should include:

1. Project Title: What are you calling your project?

2. Project Description: a brief summary (250 words maximum) of the project. Please include the main issue the project will address, approach you will take to develop the research proposal, community/ies and/or agencies that will be involved in the research development.

3. Community engagement: Describe your team’s community engagement strategies.

4. Background: Provide a brief description of the reason developing the project.

5. Rationale: A description as to why this project is important for the community you are working with. How will your project it will contribute towards building new knowledge related to Indigenous Peoples and HIV.

6. Proposed Objectives: Please identify the objectives you and your team have set out for your proposed project.

7. Activities: Please outline activities you plan to do to help your team develop a grant proposal. Who will be involved in these activities? Examples could include but are not limited to:

a. Facilitate a community dialogue;b. Hire a student researcher assistant to write and coordinate a research

grant application; and/orc. Host a team meeting where the goals, objectives and activities of the

full grant application are planned.

CHECK LIST:A complete application package will include:

This form, filled in; Attachment A: Full Proposal A two-page Project Description or summary

of your proposed activities (described below); Attachment B: Budget A completed budget Attachment C: Curriculum Vitae (CV) Free form CVs for all applicants Attachment D: Reviewers a list of reviewers you would like to suggest to

review your application or reviewers you would prefer NOT review your application.

Please note: incomplete applications will not be forwarded to review

By signing below, the Principal Applicant confirms agreement with reporting requirements and that the application is complete.

Printed Name of Principal Applicant Signature of Principal Applicant

Date: ________________________

Submissions Instructions:The final completed application, including required attachments and signatures,

must be e-mailed in PDF format to Sherri Pooyak sherrip@caan.ca