Retina Research Foundation (RRF)
Pilot Study Grant Application Checklist
Request for funding - Calendar Year 2015
DUE DATE for APPLICATIONS – IN RRF OFFICE by Mon. Oct. 27, 2014
Please complete this form & return to RRF office by e-mail in advance of/or at the time of your
grant application. Direct any questions to the office at: rrf@retinaresearchfnd.org.
A. Principal Investigator
NAME:
Mailing address:
__
______________
PhD _____ MD _____
_____________________________________________________________
_____________________________________________________________
E-mail Address:
_________
_____ _______
________________
B. Title of Research Project
______________________________________________________________________________
C. Location where research is conducted
______________________________________________________________________________
D. Total amount requested ____________________________________________________
E. Name and mailing address of official to be NOTIFIED IF award is made
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
F. Name and mailing address of official to receive PAYMENT IF award is made
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
-------------------------------------------------------------------------------------------------------------------------------------Application Checklist (for RRF office use only)
rec’d in office (date) ___________________
COVER PAGE _____ SCIENTIFIC SUMMARY _____ PURPOSE OF PROJECT _____
TYPE OF PROJECT _____ METHODOLOGY OF PROJECT _____
RESULTS PREVIOUSLY PUBLISHED _____ PROJECT BUDGET _____
SPECIAL NOTES _____ RESEARCH UTILIZATION ASPECTS _____
PROJECT PAYMENTS _____ CURRICULUM VITAE _____