NLN research nursing education grants program

NLN RESEARCH NURSING EDUCATION GRANTS PROGRAM

Demographic Data Form

Principal Investigator

Name:

Credentials:  

Title:  

Affiliating Agency:  

Business Address:  

Business Phone:  

Business Fax:  

Business Email:  

Home Address:  

Home Phone:  

Home Fax:  

Home Email:  

NLN Membership #:   Expiration Date:  

(Doctoral students who are not covered through agency membership, please contact *****@***org ).

Please consider this proposal for: (check all that apply)

NLN Research in Nursing Education Grant award (must include comprehensive file and budget as outlined in the proposal guidelines)

NLN/MNRS Doctoral Research Award*

MNRS Membership #: Expiration Date:

NLN/SNRS Dissertation Research Award*

SNRS Membership #: Expiration Date:

Mary Anne Rizzolo Doctoral Research Award*

*For doctoral awards: Be sure to include a letter of support indicating that your research has been approved by your dissertation/scholarly project committee.

Co-Investigators (if applicable)

Name, Credentials, Title, Affiliation, & Email of Co-Investigator #1

 

Name, Credentials, Title, Affiliation, & Email of Co-Investigator #2

 

Name, Credentials, Title, Affiliation, & Email of Co-Investigator #3

 

Grants Office at Principal Investigator’s Institution (skip if applying for the NLN/MNRS or Mary Anne Rizzolo doctoral research awards)

Name of Grants Office Director:  

Phone Number:  

Email Address: