Thoracic Surgery Foundation for Research and Education
633 N. St. Clair Street, 23rd Floor
Chicago, IL 60611
312-202-5868
[email protected]
TSFRE Simulation in Thoracic Education Grant Application
Deadline: October 15, 2013 11:59 p.m. CST
Application Guidelines: This document is not an online application and cannot be submitted through the
TSFRE website. To use this application, save to your desktop and submit with attachments to
[email protected]. It is preferred that all application documents are submitted together.
*Required fields
General Information
*Title of Project:
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*Duration of Project:
1 Year ☐
*Total Funding Amount Requested:
2 Years ☐
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(Budget details are requested on page 2)
Individual
*First Name:
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Middle Initial:
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*Last Name:
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Suffix:
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Degree(s):
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Gender:
Male
*Telephone Number:
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Fax:
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*E-mail Address:
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*Street Address:
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☐
Female ☐
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*City:
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*Postal Code: Choose an item.
*State/Province:
*Country:
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Sponsoring Institution
*Institution Name:
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*Your Position at This Institution:
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*Department:
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Narrative
*Abstract (500 words)
Identify the outcomes measures that demonstrate effective educational experience from simulation. This
element should be brief and specific. Applicability to future education in thoracic surgery should be
defined.
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*Background & Significance (500 words)
As this grant is intended as a pilot grant, previous results are not expected. However, background
information to support the probability of successful simulation should be included.
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*Methodology (750 words)
A complete description of the simulation must be included. Explain how students will interact with the
simulated environment and define measurable outcomes. (Attach methodology separately if more space
is needed.)
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*Budget (500 words)
Outline costs of the entire project under the broad categories of personnel, equipment, and supplies.
Indicate the sources of all funds necessary to complete the project. The Foundation does not support the
costs of consultants, travel, or graphics. A complete budget summary to justify requested support must be
included.
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*Literature References (750 words)
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Key Collaborators (Including Educational Specialists)
List the first and last names, e-mail addresses and CV in NIH Biosketch format of all project participants.
*These fields are required if you have project participants. If you do not, you may leave fields blank.
1. First Name:
Last Name:
E-mail Address:
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2. First Name:
Last Name:
E-mail Address:
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3. First Name:
Last Name:
E-mail Address:
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4. First Name:
Last Name:
E-mail Address:
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5. First Name:
Last Name:
E-mail Address:
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Payee of Award
List the institution that will receive the award check.
*Check should be made payable to:
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*Attention (name):
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*Telephone Number:
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Fax:
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*E-mail Address:
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*Street Address:
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*City:
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*State/Province:
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Institution Tax ID #:
*Country:
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Miscellaneous
Attach any other relevant data, such as figures, additional letters of support, etc.
Attachments Reminder
*Your Curriculum Vitae (pdf)
*Curriculum Vitae of any Key Collaborators (pdf)
*Methodology (If not fully explained within application) (jpeg)
*Your Photo (jpeg)
*Letter of Support from Division or Department Chair (pdf)
*Letter of Support from official authorized to commit additional institutional support (if you are receiving
institutional funding for your research). (pdf)
Other relevant data, such as figures, additional letters of support, etc. (pdf)
Submit all application materials to [email protected] by October 15, 2013 11:59 p.m. CST.
Copyright© 2013 Thoracic Surgery Foundation for Research and Education
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