Children’s Hospital Research Institute of Manitoba
513-715 McDermot Ave., Winnipeg, MB R3E 3P4
(204) 789-3447/ Fax (204) 789-3915
Operating Grant Checklist
Please check the Grants and Awards Guide for grant application deadlines.
Late applications (after 3:00 PM on the deadline date) will not be accepted.
A hard copy of the application form and attachments should be sent (in person or by mail) to the MICH
Administration Office:
Children’s Hospital Research Institute of Manitoba Administration Office
ATTN: Grants Administrator
Room 513 John Buhler Research Centre
715 McDermot Avenue
Winnipeg, MB R3E 3P4
Applicants should email an electronic version of the complete application consolidated into a single PDF
document to [email protected].
Incomplete, inaccurate or otherwise improperly prepared applications
will NOT be reviewed
Checklist of documents to include in the submission:
Signature Page completed
Operating Grant Form completed
Letter of Intent attached
Invitation to submit a Full Application attached
Major Operating Grant Checklist attached
Current Canadian Common CV of each applicant attached
Budget filled out (does not exceed maximum of $40,000.00)
Other supporting documents attached, limited to:

Letters of Collaboration

Letters of Support;

Quotes and

Regulatory Approvals
Original printed copy of Operating Grant Form and all attachments
Electronic copy (one PDF file) of Operating Grant Form and all attachments
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Children’s Hospital Research Institute of Manitoba
513-715 McDermot Ave., Winnipeg, MB R3E 3P4
(204) 789-3447/ Fax (204) 789-3915
Operating Grant Research Module
Applicant surname:
Section 1.
Summary Information
Enter text in the indicated boxes. Click on relevant check boxes in section 7. Save completed application as
<your surname>-<year>.doc (or docx).
I.
Name of Applicant - Principal Investigator:
II.
Contact Information
Mailing Address :
Telephone:
Fax Number:
Email Address:
III.
University Department:
IV.
Project Title:
V.
Other Applications:
Please provide details as to all other application(s) that have been previously made, or are being concurrently
made, to CHRIM and/or other funding agencies, for funding of this project or similar one(s) in terms of subject or
area of research for the past three (3) years.
Repeat for each application:
Funding Agency:
Type of funding and amount:
Project Info:
Funding term:
to
Funding amount approved / denied (if denied, please attach copy of the review decision and Scientific Officer
notes for each instance)
Project Outcomes and tie-in with present Project (if any):
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Children’s Hospital Research Institute of Manitoba
513-715 McDermot Ave., Winnipeg, MB R3E 3P4
(204) 789-3447/ Fax (204) 789-3915
VI.
Co-investigators:
Roles & Responsibilities
Please briefly describe the roles and responsibilities of the Principal Investigator and co-investigator(s),
including any trainee(s):
Name
Roles/Responsibilities
VII. Certification regulatory bodies - attach documentation
Obtained
Ethics approval - Human Subjects
Ethics CAC PMR - Animals
Biohazards or other containment
Other:
Pending
N/A
VIII. Signatures
The signature of the applicant below indicates that each investigator:
i. Attests to the completeness, accuracy, and correctness of the information provided in this
application;
ii. Has an appointment that provides adequate time and access to facilities to conduct the proposed
research and the absence of any other impediments to the conduct of that research;
iii. Agrees that all information and materials provided in connection with this application may be
reproduced disseminated, and used by the Manitoba Institute of Child Health for any purpose at any
time; and
iv. Agrees to comply with all requirements of the Manitoba Institute of Child Health, including its policies
and funding guidelines.
Applicant:
Department Head:
Date:
Date:
Page 3 of 7
Children’s Hospital Research Institute of Manitoba
513-715 McDermot Ave., Winnipeg, MB R3E 3P4
(204) 789-3447/ Fax (204) 789-3915
Applicant surname
Section 2.
Child Health Relevance - limit 100 words
Funding from CHRIM is dedicated to support research projects with direct relevance and benefits to child health.
Please articulate how the presently proposed project is relevant to child health, and how the anticipated
outcomes of the project will directly benefit child health.
Applicant surname
Section 3.
Lay Summary - maximum 1 page
This section should explain your project in terms that can be understood by a non-scientist. Please avoid
technical terms, acronyms and jargon. This section or extracts of it may be used in publications, announcements
and releases by CHRIM.
Applicant surname
Section 4.
Project abstract summary– maximum 1 page
Summarize your project in scientific terms. Include hypotheses to be tested, specific aims, nature of
experimental subjects, main methods to be used, and outcomes expected from 1 year of support.
Applicant surname
Section 5.
Background – maximum 1 page, plus a maximum of 1 figure as appendix
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Children’s Hospital Research Institute of Manitoba
513-715 McDermot Ave., Winnipeg, MB R3E 3P4
(204) 789-3447/ Fax (204) 789-3915
Applicant surname
Section 6.
Research Description – maximum 5 pages (not including references), plus a maximum of
2 figures as appendices.
Please describe your project including background, methods, research design, significance of the research and
possible future research directions including likely future sources of support. An addendum may be attached
containing figures and references. Include brief description of any current or proposed trainees or staff who will
participate in this project and specific responsibilities.
Applicant surname
Section 7.
Project Schedule and Milestones – attach chart if preferred
Timing (start and end dates)
Project Task/Activity
Page 5 of 7
Project Milestones
Children’s Hospital Research Institute of Manitoba
513-715 McDermot Ave., Winnipeg, MB R3E 3P4
(204) 789-3447/ Fax (204) 789-3915
Applicant surname
Section 8.
Budget
Please express figures as round dollars only. Please note that operating grant funds may NOT be used for
travel to research meetings or trainee support (incl. stipends). More information about eligible expenses can be
found in the Grants and Awards Guide.
I.
Personnel
Description
Annual Full salary
%time
for this project
(i)
(ii)
(iii)
(iv)
Total salary
Benefits (salary x 20%)
Total Personnel
II.
Disposables and supplies
Animal charges
Chemicals and reagents
Other disposables
Total Disposables and Supplies
III.
Small equipment – total maximum $5,000
Description
(i)
(ii)
Cost
Total Small Equipment
IV.
Other services – detail required
Travel for the purpose of performing Project
Shared equipment charges
Other
Total Other Services
Total Budget (1 year)
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actual salary
(without benefits)
Children’s Hospital Research Institute of Manitoba
513-715 McDermot Ave., Winnipeg, MB R3E 3P4
(204) 789-3447/ Fax (204) 789-3915
Applicant surname
Section 9.
Budget Justification – maximum 2 pages
Please provide a detailed justification of your budget.
Applicant surname
Section 10.
Other Resources for the Project – to be provided by Other Source(s)
Requisite
Y/N
Type/Source/Value/Which Part of Project
Date
Requested
Date
Secured
Co-funding
Personnel services
Materials / Reagents
Facility / Equipment
Data / Software
Other (specify):
Applicant surname
Section 11.
Supporting documents
Use the section below to make a list of the supporting documents you have provided. Include scans of any
supporting docs in the electronic version of this application, to be submitted as one PDF file.
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