NBRC Frederic Helmholz, Jr., MD Educational Research Fund Application

Use the form below to apply for the NBRC Frederic Helmholz, Jr., MD Educational Research Endowment. Use English only and avoid jargon and unusual abbreviations.

Do not submit an incomplete application. Do not submit additional material pertinent to an application after the receipt date, unless it is requested or agreed to by prior discussion with the Chairman of the ARCF Board of Trustees.

A complete application should be submitted by June 1 for consideration of the annual award. The ARCF Board of Trustees will utilize appropriate consultants to assure a complete review of the application. Applicants will be notified by August 1 of the ARCF’s decision regarding award of a grant. The grant and certificate are presented at the AARC Awards Ceremony during AARC Congress. The ARCF will cover the travel expenses for the award recipient to attend the AARC Congress to receive the award.

The ARCF reserves the right to recall funds granted for a project, if they are being misused or if sufficient progress is not being made.

Summary reports must be submitted periodically and must be properly identified with the title and name of the principal investigator. Publications related to the research must acknowledge the support of the ARCF; five reprints of such reports must be sent to the ARCF upon publication.

Application
Who is applying for the research grant?
- An individual
- An institution/organization
Email*
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Applicant Information
Name*
First Last
Position Title*
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Phone*
Social Security Number
Applicant Information
Name of Institution/Organization*
Mailing Address*
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Project Information
Are human subjects, derived materials, or data involved?*
- Yes
- No
Date of Proposed Project Start*
MM slash DD slash YYYY
Date of Proposed Project Finish*
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Performance Sites*
(list organizations and addresses where the project will be conducted)
Were any inventions conceived or reduced to practice during the course of the project?*
- Yes
- No
Abstract of Research Plan
Title of Research Project*
Purpose*
(e.g., master’s thesis, doctoral dissertation, investigative research)
All Personnel Engaged in Project, Beginning with Prinicpal Investigator/Program Director*
Name Title Dept.
Abstract*
Concisely describe the application’s specific aims, methodology and long-term objectives, making reference to the scientific disciplines involved and the health-relatedness of the project. The abstract should be self-contained so that it can serve as a succinct and accurate description of the application when separated from it.
Practical Value*
Describe the practical value of the educational or credentialing research to the profession.
Signature of Principal Investigator/Program Director
Name*
Date*
MM slash DD slash YYYY
Certification*
I agree
I agree to accept responsibility for the scientific conduct of the project and to provide the required progress reports if a grant is awarded as a result of this application.
Signature of Applicant Organization Official (if other than principal investigator)
Name
Date
MM slash DD slash YYYY
Certification
I agree
I agree that the statements herein are true and complete to the best of my knowledge, and accept the obligation to comply with ARCF terms and conditions if a grant is awarded as a result of this application.
Phone
This field is for validation purposes and should be left unchanged.

Name	Title	Dept.

NBRC Frederic Helmholz, Jr., MD Educational Research Fund Application

Application

Applicant Information

Applicant Information

Project Information

Abstract of Research Plan

Signature of Principal Investigator/Program Director

Signature of Applicant Organization Official (if other than principal investigator)