APPLICATION FOR CWN SUPPORT
for National Research Team and Proposal Development
Intersectoral prevention strategies to address impacts of hydraulic fracturing on
Aboriginal communities
Submission deadline: September 9, 2015
Instructions
Please complete this form as your application for CWN support. All fields must be completed and
submitted no later than September 9, 2015 11:59 pm (midnight) Eastern Daylight Time.
This is not a request for proposals. The intent of the current call for applications is to identify a strong
national team with a strong concept that CWN can support in developing a proposal to CIHR and assist
in attracting additional partner contributions. The successful team will be notified by CWN no later than
September 16, 2015.
When complete, the application form should be no longer than 7 pages, including tables and images.
Please use a minimum of 11-point font.
Text box fields allow tables and images to be inserted. The text boxes on the form pages can be
completed by copying from another text document (using the ‘Ctrl’ and ‘v’ keys). Please make liberal
use of line spaces and capitals to make the text easier to read. You will not be penalized for using white
space.
You may contact CWN for assistance:

If you require technical help with this form, contact Janice Levangie at jlevangie@cwn-rce.ca or
519-888-4567 ext. 39354.

If you have questions about the desired content of the application, please contact Katrina
Hitchman at khitchman@cwn-rce.ca or 519-888-4567 ext. 37943.
1. Nominated principal applicant information
Provide the following details for the individual acting as the team lead and key point of contact for this
application.
Last name:
First name:
Title:
Department:
Institution:
Telephone:
Fax:
Email:
Street address:
City:
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Province:
Postal code:
Application for CWN support – Intersectoral prevention research
2. Proposal concept
Provide a high level overview of the approach your team would take to respond to the CIHR funding
opportunity within the framework provided by CWN. That is, how would your team assess the suitability
of current regulations, policies, and systems to prevent health impacts of hydraulic fracturing activities in
Aboriginal communities? How would you design a project comprising studies and comparative
assessments to provide concrete value by directly informing policy and practice decisions with a
demonstrable expectation of improved prevention of negative health outcomes?
(Maximum 750 words)
3. Project team
Describe the members of the proposed project team (including extended project partnerships) and
indicate each team member’s anticipated role in the project.
Please distinguish between the independent researchers for whom you would seek CIHR funding and
knowledge users, other researchers, and partners who would provide input but would be supported
through “leveraged” or in-kind funding from other sources. To indicate overall capacity, you may list
separately those likely to contribute to the projects in an advisory capacity.
Please indicate clearly which principal applicant will be the designated Traditional Knowledge
Keeper/Elder for the team.
Briefly list each team member’s area of expertise and outline their research excellence, qualifications
and experience for their proposed role in the project.
If additional rows are needed please contact Janice Levangie at jlevangie@cwn-rce.ca.
(Maximum 1.5 pages)
*For more details on CIHR’s team composition eligibility requirements, refer to the CIHR Team Grant: Environments and
Health: Intersectoral Prevention Research funding opportunity website.
Independent researchers (supported by CIHR funding)
Name
Academic
institution
Project role
Area of expertise/qualifications
*Nominated
principal applicant
*Principal applicant
Knowledge users, other researchers, and partners (supported by other leveraged or in-kind
funding)
Name
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Organization
Project role
Area of expertise
* Knowledge user
and principal
applicant
Application for CWN support – Intersectoral prevention research
*Knowledge user
and co-applicant
*Knowledge user
and co-applicant
Others taking part in the project in an advisory capacity
Name
Organization
Project role
Area of expertise
4. Team composition and structure
Describe how the proposed team’s research excellence, established competence, and experience are
well suited to address the issues adequately and achieve improved prevention of negative health
outcomes. In particular, highlight:
 How the team’s interdisciplinary, multi-institutional, intersectoral, and cross-regional makeup is
well suited to address the issues.
 The team’s experience and familiarity with relevant practices, regulations, policies, and systems,
and how the issues to be examined relate to these practices, regulations, policies, and systems.
(Maximum 750 words)
5. Existing relationships with Aboriginal communities
Describe the team’s existing relationships with Aboriginal communities located across Canada for whom
impacts of hydraulic fracturing on health are an important issue. Describe any demonstrated interest in
your proposed project from Aboriginal organizations and groups, especially Aboriginal communities,
including proposed partners.
(Maximum 400 words)
6. Additional expertise required
As appropriate, CWN may provide assistance to the successful team in connecting with additional
expertise required by the research topic. If assistance is required, briefly indicate what type of expertise
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Application for CWN support – Intersectoral prevention research
the team would benefit from adding, and what role this additional expertise would play in the proposed
project.
(Maximum 250 words)
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Application for CWN support – Intersectoral prevention research