PSYCHIATRY RESIDENT RESEARCH PROJECT
REQUEST FOR FUNDING
A.
Cover Page
Resident Name:
Year of Training:
Supervisor and Affiliations:
Committee Member/Affiliations:
Committee Member/Affiliations:
Short Title:
Signatures
Date
Resident
Supervisor
Head of Department
1Ethics
Approval: � Received (attach letter from REB) � Not applicable (provide justification here):
Applications should be submitted to:
Department of Psychiatry - Education Office
8th Floor, AJL Building
5909 Veterans’ Memorial Lane
Halifax, NS B3H 2E2
1
All human subject research requires prior ethical approval by a duly constituted Research Ethics Board (i.e., the REBs of the Capital
Health District, or IWK Health Centre). If you believe that your research project does not require ethical approval, you must justify it here.
If the need for ethical review is uncertain, a consultation with the REB may be required.
Psychiatry Resident Research Fund Application
Page 1 of 5
B.
Proposed Research Project
Summary (250 word maximum):
Full Proposal:
Starting on a separate page, review relevant background work in this area (include references),
summarizing the state of knowledge in the field and highlighting the need for the current proposed
project. Describe the objective(s) of the proposed project briefly and clearly. State the hypotheses or
question to be reviewed or tested, describe the methods to be used, any measures and outcomes to be
obtained, and a plan for statistical assessment of the results, if appropriate. The proposal should not
normally exceed five pages, not including references and any figures or tables included in an Appendix.
Psychiatry Resident Research Fund Application
Page 2 of 5
C.
Learning Objectives
Describe the learning objectives and the role of the resident in this project:
Psychiatry Resident Research Fund Application
Page 3 of 5
D.
Funding Requested
Total funding will not exceed $2,500. Costs of research assistant salary, travel, meetings and
publications/presentations are not normally eligible for funding. Note that GST is charged on all
purchases at a net rate of 4.62% and should be included in the budget. If this funding will supplement
an ongoing, funded project, expenses should not overlap those of the already funded budget (submit
funded budget with application).
*Note: Original receipts must be submitted for reimbursement of expenses.
Total Funding Requested:
Detailed Budget:
Expense
$
Total
$
Justification for each expense should be provided here and on additional pages if needed:
Psychiatry Resident Research Fund Application
Page 4 of 5
E.
Supervisor and Committee
Provide a statement from the supervisor that the outlined project has been reviewed and the
supervisor is willing to provide the necessary supervision and resources (beyond those requested
here) needed to fulfill the research project requirements.
The proposed project proposal has been reviewed for scientific merit and feasibility by:
______________________________________(Print Supervisor’s name). The supervisor confirms that:
1. I am the primary supervisor of the project.
2. The project as described meets with my approval and I am willing to provide supervision and
resources as needed for the completion of the resident research project requirement.
Signed,
__________________________________________
SIGNATURE OF SUPERVISOR
________________________
DATE
Research Project Committee:
The project has been reviewed and approved by the other members of the research project committee.
__________________________________________
SIGNATURE OF EDUCATION SECTION
COMMITTEE MEMBER
________________________
DATE
__________________________________________
SIGNATURE OF RESEARCH SECTION
COMMITTEE MEMBER
________________________
DATE
Psychiatry Resident Research Fund Application
Page 5 of 5