Research Proposal Submission Form

Thank you for your interest in conducting research within the WVACHS. Please provide answers to the following questions below. Your proposal will be evaluated according to the following seven criteria: 1. potential impact for patients and communities served; 2. feasibility of study implementation and completion; 3. appropriateness of study design; 4. relevance to the needs and demands of primary care; 5. passion for including this work within the WVACHS; 6. reasonableness of the estimated project timeline; 7. reasonableness of the proposed budget and allocation of potential mini-grant funding.

Name

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Organizational Affiliation

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Co-Investigator Name

Organizational Affiliation

Co-Investigator Name

Organizational Affiliation

Co-Investigator Name

Organizational Affiliation

Co-Investigator Name

Organizational Affiliation

Co-Investigator Name

Organizational Affiliation

Project Title

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Specify the research question.

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Describe in detail the analytics approach, including needed sample size.

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How is the proposed research relevant to the health and wellbeing of Appalachia, and how does it support primary care?

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Is Institutional Review Board approval for this research in-place?

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Yes No

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Provide an estimated project timeline.

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Lastly, a $3,000 mini-grant may be available for your study depending on funding availability. Describe how you propose to allocate that funding if awarded. Please also describe any additional known research expenses.

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