TVN File #: FRA 2015-A-## (SURNAME, First Name)
Please read the Program Guidelines and Application Instructions before completing this application.
TVN funding competitions follow the Tri-Council Guidelines and thus all questions related to partner eligibility, budget considerations (e.g. in-kind eligibility) and HQP follow the Tri-Council Guidelines
( http://www.nserc-crsng.gc.ca/NSERC-CRSNG/policies-politiques/index_eng.asp
). Applicants should also direct these and similar questions to their host institution’s research services office/unit for further assistance.
Full applications will only be considered if an Intent to Apply is received by 5 pm ET on Monday March 23,
2015. Full applications are due by 5 pm ET on Monday, April 27, 2015.
Section 1: Project Overview
Proposal LAY Title (max 15 words):
Term Requested (6 months maximum):
Project Leader:
Identify ONE principal investigator responsible for managing the project.
First Name: Last Name: Designations:
Email: Daytime Phone:
Budget Requested ($50,000 maximum):
Other Phone (optional):
Host Institution that will receive and administer funds:
Secondary Contact Name: (Project Manager, Assistant, etc.) Secondary Email:
TVN Strategic Objective -- Select the ONE TVN strategic priority this project most closely aligns with:
 Matching care to values
 Empowering, engaging and supporting patients and their families/caregivers
 Improving clinical outcomes
 Improving care across the continuum
Theme -- Select the ONE research theme this project most closely aligns with:
 Improved end-of-life care/advance care planning
 Improved acute/critical care
 Optimization of community/residential care
 Optimization of transitions of care
Setting of Care -- Select the ONE setting of care that your project will most significantly impact:
 Palliative/EOL care




Acute/critical care in hospital
Long-term care facility
Home care
All settings of care
Focus of Impact -- Select the ONE primary focus of impact for your project:
 Patients, their families and informal caregivers/support systems (volunteer)
 Health care professionals and caregivers (paid)
 Health care facilities
 Health care system
Knowledge Activities -- Indicate the portion of your project that addresses the following activities on the knowledge continuum:
____ % Knowledge synthesis ____ % Knowledge creation ____ % Knowledge translation/mobilization
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TVN File #: FRA 2015-A-## (SURNAME, First Name)
Project Summary (max. half page)
Provide a non-confidential Executive Summary in lay terms of the proposal, highlighting project objectives and deliverables and potential socioeconomic impact. (Note: This summary will be evaluated by lay and scientific reviewers. Furthermore, for successful proposals, this summary may be used in press releases, communications, and/or posted on the Network’s external web site).
Research Ethics/Environmental Assessment
Please answer the two questions below.
1.
Research Ethics: If the proposed research involves biohazards, humans, human embryonic stem cells or animals, AND is funded by TVN, certification of approval by your institutional certification committee must be provided to TVN prior to the release of funds.
⃝ Yes, I expect that this research will require an ethics review
⃝ No, I do not expect that this research will require an ethics review
2.
Environmental Assessment: Does any phase or part of the research described in this proposal a) take place outside an office or laboratory, or b) involve an undertaking as described in part 1 of
Appendix B of the Natural Sciences and Engineering Research Council of Canada (NSERC) Form
101 ( http://www.nserc-crsng.gc.ca/OnlineServices-ServicesEnLigne/pdf/F101_e.pdf
)?
⃝ Yes, I expect that this research will require an environmental impact review
⃝ No, I do not expect that this research will require an environmental impact review
If you answered yes to this question, and your project is selected for funding by TVN, you will be required to complete an Environmental Assessment Impact Statement and the Canadian
Environmental Assessment Act Pre-Screening Checklist for review and approval by TVN before funds will be released.
(6 page maximum for this section)
2.1 Background, Scope of Work and Project Relevance
State the proposed research question and provide a description of the team's understanding of the scope of work related to Frailty Measures as described in the Guidance document. Provide adequate background rationale including a systematic or comprehensive review of the literature that identifies the knowledge gap or rationale for the research proposal. Where applicable, clearly state the underlying hypothesis.
2.2 Methodological Approach
Provide the proposed approach including methodology (such as inclusion of a scoping phase; databases & grey literature to be searched; search terms; use of key informants; inclusion and exclusion criteria) and data abstraction process(es).
2.3 Project Relevance and Impact
Describe the relevance and the importance of the proposed project to TVN`s mission and strategic research programme goals, priorities, and potential to assist TVN in achieving a positive impact on
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TVN File #: FRA 2015-A-## (SURNAME, First Name) policy and practice. Also, identify how the proposal meets the specific objective of assisting in increasing the socio-economic benefit(s) to the seriously ill frail elderly in Canada.
2.4 Research Deliverables and Milestones
Briefly summarize the research deliverables (at the conclusion of the project) and associated milestones/timeframes over the duration of the project. These milestones will be used to track progress with the grant and linked to ongoing payments. Identify all feasibility issues and limitations, and what the investigative team will do to overcome them. Include a summary of how this project will be managed and deliverables tracked.
2.5 Contribution to HQP
TVN funded proposals must contribute to the development of Highly Qualified Personnel through their inclusion as fully involved team members. Briefly summarize the number and level of HQP required and the experience/expertise afforded by involvement in Network-funded research. Specify expected contributions to HQP studies.
2.6 Project Networking and Engagement
Describe the networking and engagement planned for this project across disciplines, research sites
(universities, hospitals, institutes), and sectors. Projects that represent collaborative efforts of several
Investigators in more than one discipline (e.g., combinations of biomedical science, natural sciences and/or the social sciences) and/or at more than one Institution and/or with involvement of partners and stakeholders from other sectors are important to the development of the Network and will be more favourably reviewed.
The Network is committed to empowering and engaging the seriously ill, and their families. Describe how your project will engage with these patients, families and/or other knowledge users.
2.7 KT Framework/Platform
Please identify the KT framework that will be used and how it will be implemented. The framework should be one from the April 2012 Knowledge Translation Framework for Ageing and Health from the
World Health Organization ( http://www.who.int/ageing/publications/knowledge_translation.pdf
).
2.8 Potential for Knowledge Translation/Knowledge Mobilization/Commercialization
Describe the opportunities for knowledge translation and exchange and/or technology transfer or commercialization of the research proposed along a continuum leading to social or economic impacts or policy and practice change. If there are specific companies or organizations that will be involved, list in Section 3 (Partnerships) and ensure that a letter of support is included.
(No maximum page limits for this section)
List each organization that will partner in the project, their specific roles (i.e. research receptor, knowledge user, financial/in-kind support), and the cash and in-kind contributions anticipated from the partner(s) to the project. All financial information provided in the table below should also appear in the pertinent areas of the project budget, and individuals from these organizations that will be participating as project team members should also be listed in the Project Team List.
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TVN File #: FRA 2015-A-## (SURNAME, First Name)
Applications must demonstrate partnerships which will likely lead to uptake on project results. Only applications that include funding with committed cash or in kind contributions from NCE eligible partners valued at a minimum of 25% of the TVN funding request will be considered.
Where a researcher has a “financial interest” (as defined by NCE Conflict of Interest Guidelines) in a partner, the potential conflict of interest should be declared. This does not preclude the partnership in any way, but provides transparency to the review process. Please see TVN Conflict of Interest Policy
and Guidelines available on the TVN website for further information
Please see the Application Instructions for guidance on allowable expenses and eligible partners and contributions.
Partner Organization/
Research Receptor
Insert additional rows as needed
Potential
Conflict of
Interest
(Yes or No)
Role in Project and Specific Use of
Contribution in Project
Nature of
Contribution
(cash or inkind)
Contribution
Amount (CDN$)
Please provide a letter of support on the letterhead of each eligible partner detailing the extent of their collaboration and/or their cash and in-kind contribution towards the particular project. The letter should specifically include reference to TVN, the proposed project, and any conditions placed on funding.
Please provide details of other funding applied for that could leverage/support your Network proposal.
By person, for the Project Leader, all other Principal Investigators, and all Co-Investigators, list all grants currently planned to be applied for, being applied for, pending, about to be submitted, and all grants received, for the entire period covered by this application.
Status Funding Source Amount Purpose
Include one chart per person, and Insert additional rows as needed
% Overlap with this application
Scientific Financial
References
Tables, Figures
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