THRIVE Research Project Proposal Form
Please submit the following information about the proposed project to:
Mark Carroll
Flagstaff Medical Center CMO/Vice President
NAH Vice President Population Health & Care Management
Northern Arizona Health Care
1200 North Beaver Street
Flagstaff, AZ 86001
928-773-2101
Email: Steven.lewis@nahealth.com
Robert T Trotter, II
Associate Vice President for
Health Research Initiatives
Northern Arizona University
Campus Box 4087
Flagstaff, AZ 86011
928-523-4521
email: Robert.trotter@nau.edu
TITLE OF PROPOSAL:
LEAD INSTITUTION (NAH/NAU):
COLLABORATING INSTITUTION(S) (NAH/NAU/Others):
LEAD INVESTIGATOR/Institutional Affiliation:
COLLABORATING INVESTIGATOR(S)/Affiliation: (This can include a request for researcher
“matchmaking” for either institution
PROJECT DESCRIPTION/SUMMARY:
RESOURCE NEEDS:
a. Funding Sources (including deadlines): Reminder: THRIVE is not a direct source of
funding for most projects, but will act as an institutional partner in grant
development). However, having the following budget information is useful for the
overall decisions.
a. Budget estimate
b. Direct costs
c. Indirect costs
d. Matching requirements, if any
b. Facilities, Equipment, Lab
c. IRB, other regulatory
Project Contact(s);
Name:
Address:
Phone:
Email: