PAF - 2017 NIDA Mentored Outreach Award Application

NIDA Mentored Outreach Award in Substance Use Disorders (SUD) Treatment Dissemination

Supported by the National Institute on Drug Abuse (NIDA) from the National Institutes of Health (NIH) in partnership with the PA Foundation

Step 1: Review the requirements document.

Step 2: Fill out form below and upload all required supporting materials.

Application Deadline: EXTENDED - December 4, 2017

Name of Applicant *

AAPA ID: * 🛈

Applicant Street Address *

Address Line 2

City *

State *

Zip Code *

E-mail: *

Phone Number *

Fax:

Name of Project: *

Abstract/Brief Description of Project (250 word maximum): * 🛈

0/250 words

Candidates cannot have had previous or simultaneous funding from the National Institutes of Health (NIH) or research funding sources. Eligible candidates may not have a previous training award. Please check the following statements to confirm you meet the eligibility criteria. *

I have not received previous funding from the National Institutes of Health (NIH).

I have not received a previous training award from NIDA.

Attestations: *

I attest that the contents of this grant application are true and accurate. I agree that if awarded a grant, information about this project and my photograph may be published in AAPA and PA Foundation publications and news releases.

I attest that the individuals and organizations applying for this grant do not advocate, support, or engage in discrimination in the provision of health care on the basis of age, color, disability, ethnicity, gender identity or expression, national origin, union membership, political affiliation, race, size, religious affiliation, sex, sexual orientation, or socioeconomic or veteran status.

I understand that this funding cannot be used to support new, free-standing pilot studies, clinical trials, or clinical research studies.

I understand that if selected to receive an outreach award, I will be required to submit a 6-month narrative progress report and a final narrative report at the end of the performance period; attend and present a poster at the 2019 AAPA Annual Conference on May 18-22, 2019, in Denver, CO; and attend the NIDA Clinical Trials Network Annual Steering Committee Meeting on March 20-22, 2018, in Bethesda, MD.

SUPPORTING DOCUMENTS

Attach written proposal/project plan with timeline for project funding year (maximum 5 pages): * 🛈

Attach detailed project budget and budget justification: * 🛈

Attach current biosketch/CV: *

IF APPLICABLE: Attach letter of support if the proposed project uses facilities not routinely available to or directly under the supervision of the sponsoring program.

IF APPLICABLE: Attach statement of support from local mentor.