Canadian Nurses Foundation Nursing Care Partnership
DATA COLLECTION SHEET
Please complete the Data Collection Sheet on your computer and submit it via email three weeks
prior to the proposal submission closing date i.e. February 8th for March 1st review to
mphelan@cna-aiic.ca.
1. Funding Partner:
2. Project Title:
3. Expected start date for project (month, year):
4. Expected finish date for project (month, year):
5. Reporting:
Progress Report Date (1 year from project
start date):
6. Budget
a) Total Budget:
Year 1:
Final Report Date (within 6 months of project
completion):
Year 2 if applicable:
Year 3 if applicable:
b) CNF/NCP Share of Funding (up to 1/3 of total cost of project per year)
Year 1:
Year 2 if applicable:
Year 3 if applicable:
7. How is the project likely to impact nursing practice (directly or indirectly)?
8. Principal Investigator(s)
Name and educational credentials
Organization & Position
Contact Information (postal
address, phone, e-mail)
Is the P.I. a nurse?
Yes ____ # of Years Experience
Is the P.I. doing post-doctoral fellow research?
Name and educational credentials
Organization & Position
Contact Information (postal
address, phone, e-mail)
Is the P.I. a nurse?
Yes ____ # of Years Experience
Is the P.I. doing post-doctoral fellow research?
_____
The P.I. is not a nurse. _____
Yes _____ No _____
_____
The P.I. is not a nurse. _____
Yes _____ No _____
Canadian Nurses Foundation Nursing Care Partnership
DATA COLLECTION SHEET
9. Co-Investigator(s)
Name and educational credentials
Organization & Position
Contact Information (postal
address, phone, e-mail)
Is the co-investigator a nurse?
Yes ____
The co-investigator is not a nurse. _____
Is the co-investigator doing post-doctoral fellow research?
Yes _____ No _____
Name and educational credentials
Organization & Position
Contact Information (postal
address, phone, e-mail)
Is the co-investigator a nurse?
Yes ____
The co-investigator is not a nurse. _____
Is the co-investigator doing post-doctoral fellow research?
Yes _____ No _____
Name and educational credentials
Organization & Position
Contact Information (postal
address, phone, e-mail)
Is the co-investigator a nurse?
Yes ____
The co-investigator is not a nurse. _____
Is the co-investigator doing post-doctoral fellow research?
Yes _____ No _____
Name and educational credentials
Organization & Position
Contact Information (postal
address, phone, e-mail)
Is the co-investigator a nurse?
Yes ____
The co-investigator is not a nurse. _____
Is the co-investigator doing post-doctoral fellow research?
Yes _____ No _____
(If more than 4 co-investigators, please add the above information for each)
10. Disciplines involved as researchers on the project team (e.g. nursing, medicine, physiotherapy,
psychology, etc.):
Nursing
Medicine
Physiotherapy
Psychology
Other
11. Are there novice researchers involved?
Yes/No
Name
12. Geographic location of the research?
Province/territory
13. Setting(s) for the research (name of organization(s) and type – e.g. long term care, acute care,
educational etc.):
Organization(s)
Type