Surgery Strategic Clinical Network
SEED Grant Program 2016
Application Template
Instructions for Applicants
Step 1 – Complete Sections A and B
 Complete Sections A and B of the template including abstract, project proposal, budget and references.
 Save this form in the following format:

PrincipalInvestigatorsLastName_FirstName_SGP2016-SectionA.doc

PrincipalInvestigatorsLastName_FirstName_SGP2016-SectionB.doc

Save file using Microsoft Word or equivalent; do not submit scanned copies for these sections.
Step 2 – Complete Section C and Supplementary Documents
 Complete Section C – Investigator Information and Institutional Approval
o
Save this form in the following format:
 PrincipalInvestigatorsLastName_FirstName_SGP2016-SectionC {pdf}
 Provide an abbreviated version of the PI’s Curriculum Vitae (Maximum 5 pages)
o Save this form in the following format:
 PrincipalInvestigatorsLastName_FirstName_SGP2016-CV (pdf or doc)
Step 3 – Send all completed files via email by 4:30 on May 16th, 2016:
Surgery.SCNResearch@ahs.ca
Additional notes:


Consult the University of Alberta and University of Calgary RSO’s for Institutional Approvals
Any proposals which were not funded in previous years may be revised and resubmitted
If you have any questions about this program, please contact
surgery.scnresearch@ahs.ca
Kelvin Mok – Assistant Scientific Director
Nubia Zepeda – Project Manager
Surgery Strategic Clinical Network
2016 SEED GRANT AWARD PROGRAM
Application Template
SECTION A – Proposal Summary
Please provide all the following information. Italicized words may be removed and replaced with information.
Please complete this section as formatted.
Principal Investigator(s) Please list only main investigators. You may indicate collaborators in Section B
Lastname, Firstname
Lastname, Firstname
Lastname, Firstname
Proposed Study Title (40 words or less):
Title
Proposal Abstract (250 words or less):
Please provide an executive summary for your proposal. Please capture research questions, current state of
evidence, proposal objectives, and the potential benefits to the health system or patients, where applicable
Abstract
Budget Please append a one-page document detailing the proposed budget expenditures and any in-kind
contributions, or other sources of grant funding.
Please clearly note if you have received, or previously received, funding from Alberta Heath Services and/or
Strategic Clinical Networks. Please review eligible fund expenses described in the program guide. Funding
cannot be used to cover travel expenses
Please also indicate the following total amounts here:



Total Requested Amount: $ #####.##
In Kind Contributions:
$ #####.##
Total Budget:
$ #####.##
Please indicate other sources of funding which you have received to support this research:
Surgery Strategic Clinical Network
2016 SEED GRANT AWARD PROGRAM
Application Template
SECTION B – Research Proposal
Please provide all the following sections (Table 1) within a research proposal using a maximum of 4
pages and following any strict limits as indicated. Please use Size 11 Arial Font Type only. You may
re-organize sections and lengths, as required, but you must keep the section titles in your proposal.
Additionally, you may include up to 2 pages of appendices.
1. Problem Statement and Significance
Please describe the issue(s) that your proposal aims to address, the significance of the problem(s), and
relevance to current priorities. (500 words or less)
2. Research Question and Objectives
Please state the research question that your proposal will address.
3. Research Methodology
Please provide an overview of the proposed research methodology, patient/subject/population
selection, study design and project timelines, data analysis, outcome measures, where appropriate and
applicable.
4. Research Outcomes and Anticipated Outcomes
Please describe how the outcomes of the planned research will be sustained long-term and how these
benefits will be realized in Alberta and other places.
5. Knowledge Translation and Dissemination
Please describe your plans to directly disseminate and translate knowledge generated from this work.
6. Improving Surgical Care in Alberta
Please indicate how this research work will improve surgical care in Alberta. (max 300 words)
7. Limitations of the Proposed Study
Please describe the expected limitations of this pilot study to address problem and propose strategies
to take following this work in order to address these.
8. Proposal Development
Which funding opportunities do you plan to pursue in order to support this work following a pilot study;
i.e. grant competitions or other sources, if applicable.
9. Research Team and Environment
Please provide a brief summary of the experience and expertise of your research team and its ability to
conduct this study (300 words or less)
10. References
References should be provided and included as part of appendices; appendices should not exceed 2
pages.
Surgery Strategic Clinical Network
2016 SEED GRANT AWARD PROGRAM
This page should be scanned separately from the rest of the application SECTION C – Investigator Information and Institutional Approval
Please provide all the following information. Please obtain all required signatures (electronic/scanned signatures are acceptable).
Please complete form, scan any printed copy and send to Surgery.SCNResearch@ahs.ca
Proposed Study Title (40 words or less):
Title
Principal Investigator
Department and Institution
Mailing Address
E-mail Address
Phone Number
Lastname, Firstname
Department, Institution
Address
E-mail
Phone Number
Co-Investigator
Department and Institution
Mailing Address
E-mail Address
Lastname, Firstname
Department, Institution
Address
E-mail
Co-Investigator
Department and Institution
Mailing Address
E-mail Address
Lastname, Firstname
Department, Institution
Address
E-mail
Co-Investigator
Department and Institution
Mailing Address
E-mail Address
Lastname, Firstname
Department, Institution
Address
E-mail
*If there are more co-applicants please append additional names here.
Investigator Information
By signing this form, the above investigators agree to have the research proposal and application materials reviewed (in confidence)
by the Surgery Strategic Clinical Network (SSCN) for the Surgery SEED Grant Award Program. The investigators also agree to be
contacted by the SSCN for matters relating to this program and dispersal of awards.
Institutional Approval
Please obtain signatures indicating approval to conduct this research study at your institution and receipt of funding from this
competition conditional to award. Note to RSOs: all research studies will be required to meet institutional requirements prior to
delivery of funding.
Name
Signature
Date
Principal Investigator:
Department Chair (or Exec.
Director for AHS Staff):
Faculty (Dean or delegate, as
required):
Research Services
Office of University, as
required:
If you have any questions about this program, please contact
surgery.scnresearch@ahs.ca
Kelvin Mok – Assistant Scientific Director
Nubia Zepeda – Project Manager