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Application Details

Projected Dates of Project:  We realize that you may not have precise dates at this time.  Your best guess will suffice.

Principal Investigator Information:

Additional Team Members/Investigators
If there are additional people on your team please add them below- you may list up to 5 total

Additional Team Member/Investigator #1

Additional Team Member/Investigator #2

Additional Team Member/Investigator #3

Additional Team Member/Investigator #4

Additional Team Member/Investigator #5

Payment Information:

Institution Information

Institutional Official

Institutional Official Contact Information:

Mentor Information
We strongly encourage our applicants to have mentors for their work, especially if you are not a highly experienced researcher. Hopefully a mentor will be available in your own institution or a nearby college/school of nursing.

Mentor: If you have a project mentor, please enter their information below:

IRB Information:

Please complete the following proposal. Please number your references throughout. (For example, “Cholesterol is comprised of two values(3)”. Then, please use APA format and detail your corresponding references on an attachment. (For example, Smith and Jones, 2012.)

 Social Determinants of Health



Describe the background of your proposal, including:

  • Review of the literature: A critical evaluation of the existing body of knowledge about the problem.
  • The significance of this study by relating it to existing knowledge. Why this work is important?
  • A description of the target population and SDOH(s) your work addresses and why (can have more than one).
  • References that are uploaded as an attachment (upload explained below).

NOTE ABOVE: Your Hypothesis should be specific.

  • Detail the methods you will use for the research/project.
    • Identify your sample (characteristics, sample size, provide power analysis as appropriate to justify your sample size). Explain the difficulty or ease you believe you will have recruiting your sample and why you feel this way. If there will be challenges, how will you overcome them?
    • Specify the protocols and instruments you will use. If you are using a particular instrument, provide a copy as an attachment. As appropriate, provide information on the psychometric properties of the instrument you are proposing to use. Please be sure you have already obtained permission to use your tools so that this study is ready to implement once your IRB has approved it and we have agreed to fund it.
  • Describe outcome variables in detail.

  • Describe your proposed data analysis plan in detail.
  • Explain how you will maintain confidentiality.

      Community Needs

      NOTE ABOVE: How does your work fit the needs of your community as described in your organization’s or your community’s assessment of the community’s needs?


      Clinical Nurse Engagement


      • Describe in detail how clinical/staff nurses will be involved in this study. E.g. in conceptualization, data collection, analysis, reporting. This is a very important component of your proposal.

      Detail your proposed step-by-step timeline, following this example. Your plan should not exceed 12 months.

      Study Timeframe

      Your Timeline:

      Create a spreadsheet identical to the one above to present your project’s timeline. Include additional steps from the EBP process model you identified previously as guiding this project work.  Please upload your timeline at the end of this application.

      Proposed Budget

      Funds are available for direct expenses only. Institutional overhead may not be included. Provide budget using the following chart and describe/provide justification for how you will use the grant funding to support your project (e.g., cost for reproduction of booklets - 500 booklets @ $2/booklet = $1000).


      Your Budget:

      Create a spreadsheet identical to the one above to present your project’s budget.  Please upload your budget below.


      DOCUMENTATION – Upload the documents listed below.

      Letter of Agreement

      Please copy and paste this onto your institution’s letterhead.  Fill in the blanks, print it out and sign it. Your Chief Nursing Officer or other Senior Administrator's signature is also required as an indication of her/his support of your work. 

      Then scan it into your computer, and upload with this application.  Your application is not complete without this document.

      Letter of Agreement:

      I, __________________________________________, Team Leader/Project Leader/Principal Investigator of the  project entitled _________________________________________________, commit the following to The DAISY Foundation in return for funding I request of $____________:


      • That funds will be used only for direct expenses as detailed in the budget provided in my application
      • That I will inform The DAISY Foundation of the actual start date of this study
      • That a check for any unused funds will be sent to The DAISY Foundation within 90 days of the project’s completion
      • That I will communicate in writing to The DAISY Foundation if my project is terminated before completion
      • That an interim report will be submitted 6 months after funding and a final report submitted within 90 days of the project’s completion. These reports will be submitted through The DAISY Foundation website.
      • That the report of my study may be posted on The DAISY Foundation website, if the Foundation chooses to do so.
      • That the DAISY Foundation is permitted to use my name/those of my team members and institution and the title and summary of my study in their marketing materials to help promote the grant program.
      • That I will submit my study to the Virginia Henderson Library of Sigma Theta Tau International within 30 days of filing my final report with The DAISY Foundation.
      • That I will credit funding from The DAISY Foundation upon publication/presentation of this research, using the authorized DAISY Foundation logo to be provided by The Foundation.
      • That The DAISY Foundation may not be held liable for any risk to the subjects of this study.


      Signed ________________________________________                           Date_________________________





      I fully support __________________________________, Principal Investigator of the study entitled ___________________________________________________ in her/his implementation of this project.


      Furthermore, I attest to the fact that nurse clinicians/staff nurses will be involved in this work, as described in the application.








      Please note: You may need to allow a few minutes for the form to process. If the form becomes stuck on "please wait" or you are not re-directed to another page after you hit submit, please email Christina Johnson at ChristinaJohnson@DAISYFoundation.org to confirm we have received your submission. Thank you!