Medical Center Staff Advisory Council Grant Application 2016 Welcome to MCSAC’s 2016 Grant Application Funding process! We are excited to receive your project for consideration. Over the years, MCSAC’s funded countless projects within VUMC to improve the lives of our patients, caregivers, faculty, and staff. We feel honored to make this great contribution to Vanderbilt. This year, MCSAC created a PDF “fill-in form” for ease of completion. If for any reason, you are unable to complete the PDF process, please contact lynn.booker@vanderbilt.edu. MCSAC will consider special circumstances. On the grant proposal, you will be asked to indicate the following: o Grant Aim (3 Aims total) o Overall proposal strategy, timeline, and impact Note: to ensure a level “playing field” for all applications, each proposal will be no longer than 4 pages, including the cover-title page. MCSAC will fund as many applications, as possible, but as funds are limited, we will be unable to accept any applications for projects or programs over $1,000. MCSAC grant awards may not be used for any of the following: routine department items, renovation of physical facilities, telephone services, laboratory or office furniture, membership dues, professional subscriptions, recruiting fees, maintenance contracts, computer equipment, personnel salary support. 1. By MAY 31, 2016, applications should be sent electronically to MCSAC@VANDERBILT.EDU and enter “Grants” in the Subject line of the email. 2. By JULY 15, 2016, the MCSAC Grants Committee will present the Committee’s 2016 recommendations to the Council and begin advising award recipients. 3. By AUGUST 31, 2016, MCSAC will disburse grant funds to recipients. Post-Award Process: 1) Note: When MCSAC funds a proposal, MCSAC requests either a report of progress/accomplishment or an “in person” presentation to the Council. This allows each grant recipient to share the project’s valuable contribution to VUMC with MCSAC. MCSAC will notify each grant recipient of the specific process post-award. 2) Please make available digital photos of the project and exercise care and use caution when photographing patients and other individuals, whom require Consent Forms, etc. If you elect to photo individuals, then each MCSAC grant recipient is responsible for securing the correct Vanderbilt authorization. Please be advised these digital photos may be uploaded to the MCSAC website. Please enter your initials to acknowledge your full understanding of item #2 above: _____________ Medical Center Staff Advisory Council Grant Application 2016 APRIL 1 – MAY 31, 2016 Title of Project: _____________________________ Program Director: _____________________________ Department Contact: (If different from Program Director) _____________________________ Name: _____________________________ Name: _____________________________ E-mail Address: _____________________________ E-mail Address: _____________________________ Title: _________________________ Title: _________________________ Department: _____________________________ Department: ______________________________ _____________________________ ______________________________ Campus Address: _____________________________ Campus Address: ______________________________ Telephone Number: _____________________________ Telephone Number: ______________________________ Fax: _________________________ Fax: ___________________ Is this your first application to MCSAC? □ Yes □ No If No, was your previous application funded? □ Yes □ No If applicable, please indicate the previous funded project? _________________________ If accepted, what Cost Center Number should MCSAC be prepared to transfer to? __________________________________ Medical Center Staff Advisory Council (MCSAC) 2016 Grant Application Medical Center Staff Advisory Council 2016 MCSAC GRANT PROPOSAL 1. Departmental Description (briefly, please tell us who are you and what do you do): 2. Project Proposal: Aim #1Aim #2Aim #33. Describe proposal’s overall strategy, timeline, and impact to the Vanderbilt community: 4. Amount of Request: 5. Budget (provide as much detail as possible): 6. Other Funding / Resources: List other sources of funding/resources for this request. Please indicate if external funding/resources have been received, committed, or projected/pending: 7. Could project be advanced or completed with partial funding? □ Yes Medical Center Staff Advisory Council (MCSAC) 2016 Grant Application □ No Medical Center Staff Advisory Council MCSAC GRANT COMMITTEE MEMBERS Below is the scoring criteria for grants: 1- Does not meet criteria/was outside the scope of our program (these include declination items listed on the grant application) 2- Meets criteria, moderately strong application, fund if possible 3- Meets criteria, strong application, recommend funding (100% or partial) Medical Center Staff Advisory Council (MCSAC) 2016 Grant Application