Access Living Application for Research Partnership

Section One: Contact Information

Collaborating Agency: *

First Name of Project PI: *

Last Name of Project PI: *

Project PI Phone Number: *

Project PI Email Address: *

Confirm Project PI Email Address: *

Confirm email address

Contact Person (if different from above):

Contact Phone Number:

Contact Email Address:

Confirm Contact Email Address:

Confirm email address

Section Two: Proposed Project

Project Title *

Type of Study (Select all that apply): *

Needs assessment

Analysis of existing data

New data collection

Intervention research/demonstration testing

Other (Please describe): Other (Please describe):

Brief description of project goals, objectives and activities *

OR: Attach project abstract summary

Maximum file size: 104.86MB

Section Three: Funding

Total Funding Amount for This Project: *

Total Funding Amount for Entire Grant (if different from above): *

Funding Amount Requested: *

Funding Period: *

Funding Source(s): *

Section Four: Project Deadlines

Letter of Intent Deadline: *

Letter of Support Deadline: *

Proposal Deadline: *

Section Five: References

Does the PI or any member of the research team have previous experience with or training in Community-Based Participatory Research? *

Yes

Please describe your previous experience with or training in Community-Based Participatory Research: *

Name of Last Community-Based Partner: *

Their Contact Information: Email Address *

Their Contact Information: Phone *

Will this project use community-based participatory research approach and methods? *

Yes

If Yes: Please describe: *

Section Six: How does this project fit into the goals of Access Living? Does this project…

…Increase knowledge of the disability community? *

Yes

Please explain: *

…Conduct research that is beneficial to the disability community in the short and long term? *

Yes

Please explain: *

…Build either Access Living or community capacity? *

Yes

Please explain: *

…Include a focus on equity and intersectionality that is representative of diverse, disabled people (e.g., by race, age, ethnicity, sexual orientation, citizenship status, gender identity, etc.?): *

Yes

Please explain: *

Section Seven: Proposed Partnership

List any past collaboration with Access Living. Include any key Access Living staff involved: *

What Access Living program(s) and/or department(s) would you like to collaborate with for this project? (Select all that apply): *

Advocacy

Arts & Culture

Communications

Community Organizing

Development

Finance/Admin

Independent Living

Policy

Youth Institute/DJMC

Other (please describe):Other (please describe):

Amount/type of in-kind contribution sought from Access Living: *

Section Eight: Proposed Access Living Staff and Role(s)

Is an Access Living staff either a PI or a co-PI? *

Yes

If no, please explain reason(s): *

What is the time commitment expected of Access Living staff? *

What are the duties/responsibilities expected to be performed by Access Living? *

What is the time commitment expected of Access Living consumers (clients)? *

Will Access Living consumers be compensated for their participation *

Yes

Please explain: *

How will Access Living consumers (clients) benefit from participation in this project? *

What, if any, kind of data or information is needed from Access Living? *

Section Nine: Collaborative Arrangements

Will Access Living be a co-owner of the data and materials produced? *

Yes

If not, please explain: *

If federally funded, will the data be made available to the public? *

Yes

If not, please explain: *

Will Access Living review any publication submitted? *

Yes

If not, please explain: *

Will Access Living be co-authors and co-presenters during dissemination? *

Yes

If not, please explain:

Is the funding amount divided evenly among researchers and community? *

Yes

If no, what percentage of the funding request is for the community (including Access Living)? *

Has funding for this project been solidified already? *

Yes

Please explain the plan for funding: *

In the areas listed on the right, will decisions be made jointly with Access Living? *

Yes

Does not apply

If no, please explain: *

In which of the following areas will decisions be made jointly with Access Living? Please select all that apply. *

Design/Methodology

Staffing

Budget

Implementation

Analysis

Dissemination

Community & Stakeholder Engagement

Actions (systems and policy changes, community empowerment, etc)

OtherOther

How will disagreements be handled? *

Section 10: Benefits to the Community

Please specify plan for broad community involvement in all phases of the research project: *

Please specify plans for presentation of the research results and actionable information to the community: *

Please specify how this project would contribute to community capacity-building, empowerment or research gaps? *

Section 11: IRB Approval

Does this project already have IRB approval? *

Yes

Is Access Living required to get approval from any IRB or be involved in the IRB process? *

Yes

OtherOther

What is the name of the organization through which this project was reviewed for Human Subjects *

Please attach consent form and proof of IRB approval

Maximum file size: 104.86MB

Section 12: Other Project Principles

How does this project include any other principles as outlined in the Access Living research principles guide? *

If you are human, leave this field blank.

Application for Research Partnership with Access Living

Research Partnership Application

Section One: Contact Information

Section Two: Proposed Project

Section Three: Funding

Section Four: Project Deadlines

Section Five: References

Section Six: How does this project fit into the goals of Access Living? Does this project…

Section Seven: Proposed Partnership

Section Eight: Proposed Access Living Staff and Role(s)

Section Nine: Collaborative Arrangements

Section 10: Benefits to the Community

Section 11: IRB Approval

Section 12: Other Project Principles

Application for Research Partnership with Access Living

Research Partnership Application

Section One: Contact Information arrowup6

Section Two: Proposed Project arrowup6

Section Three: Funding arrowup6

Section Four: Project Deadlines arrowup6

Section Five: References arrowup6

Section Six: How does this project fit into the goals of Access Living? Does this project… arrowup6

Section Seven: Proposed Partnership arrowup6

Section Eight: Proposed Access Living Staff and Role(s) arrowup6

Section Nine: Collaborative Arrangements arrowup6

Section 10: Benefits to the Community arrowup6

Section 11: IRB Approval arrowup6

Section 12: Other Project Principles arrowup6

Section One: Contact Information

Section Two: Proposed Project

Section Three: Funding

Section Four: Project Deadlines

Section Five: References

Section Six: How does this project fit into the goals of Access Living? Does this project…

Section Seven: Proposed Partnership

Section Eight: Proposed Access Living Staff and Role(s)

Section Nine: Collaborative Arrangements

Section 10: Benefits to the Community

Section 11: IRB Approval

Section 12: Other Project Principles