Contact InformationName(Required) First Last Degree(s) Academic/ Professional Title(Required) Institutional Affiliation(Required) Principal Investigator Phone(Required)Principal Investigator Email(Required) Co-Investigator(s) Contact Information (include names, emails, and phone numbers)(Required)ASE Member(s) on research team(Required)Grant Category and Disbursement InformationProposal Title(Required) Grant Type(Required) Gold Level ($500- $1,000) Diamond Level ($2500) Platinum Level ($10,000) Giant Robot Grants ($25,000) Is this proposal also being submitted to a different ASE or APDS Grant?(Required) Yes No If yes, which grant? Specify society (ASE or APDS) Is this application related to a SERF or SELF project?(Required) Yes, SERF Yes, SELF No, this is not a project related to SERF or SELF If awarded, Grant payment check should be made out to:(Required)File UploadUpload as a SINGLE PDF: Research plan (2 pages maximum): Background and Aims, Research strategy with a summary of proposed analytic strategy, 12- 24 month timetable depending on grant level (Projected start date is July 1, 2024) Please create a time table with dates and tasks. References (ICMJE formatting, no limit) Budget (1 page) Grant monies can be used for salary support of research assistants or other study staff. Please note that the budget cannot be used for indirect costs, administrative or travel costs, publication costs, or salary support for the Principal Investigator, Co-PIs, or collaborators. NIH-formatted biographical sketch Please attach NIH-formatted biographical sketches for the Principal Investigator (PI) and any co-Principal Investigators Letters of Support For multiple sites, all research sites should have one designated champion with a corresponding letter of support from the champion’s institution. Please include a letter of support from your institution. Please also provide one letter of support from any applicable groups that will be studied in this project (i.e., medical student clerkship or residency program director). Appendices (no limit) Please use this section to attach any research or survey instruments that will be used in the proposed study.Upload Proposal(Required)Accepted file types: pdf, Max. file size: 512 MB.What is your Gender Identity? This optional question is being asked for informational purposes and will in no way be used in the grant selection process. What Racial or Ethnic Groups describe you? This optional question is being asked for informational purposes and will in no way be used in the grant selection process.
