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Appendix B: CIHR HIV/AIDS CBR Program - File Review Template
[ Table of Contents ]
Application Details & Application Form
| Applicant Profile | ||||||
|---|---|---|---|---|---|---|
| Project title | ||||||
| Application # | ||||||
| Grant # | ||||||
| Stream (General or Aboriginal) | General | Aboriginal | ||||
| Funding tool (Grant type) | Catalyst Grant | Operating Grant | Workshop | CBRF | Masters Award | Doctoral Award |
| Province | ||||||
| Date of submission | ||||||
| CIHR Institute 1 | ||||||
| CIHR Institute 2 | ||||||
| Application History | ||||||
| Has applicant applied before (for any projest)? | Yes | No | ||||
| Number of previous applications | ||||||
| Is this a reapplication for the same project | Yes | No | ||||
| Number of previous applications for this project | ||||||
| Why was funding previously denied? | ||||||
| Is this an application for renewal? | Yes | No | ||||
| If yes, how many times was the project funded? | ||||||
| Did the applicant apply to enhance the project | Yes | No | ||||
| Description of enhancement | ||||||
| Collaborators | ||||||
| Pincipal Applicant | Academic | Community | ||||
| PIN of Principal Applicant | ||||||
| Community applicant (organization) | ||||||
| Academic applicant | ||||||
| Academic applicant (organization) | ||||||
| Other colloborator 1(organization) | ||||||
| Other colloborator 2(organization) | ||||||
| Other colloborator 3(organization) | ||||||
| Other colloborator 4(organization) | ||||||
| Research Area | ||||||
| Theme addressed 1 | Biomedical | Clinical | Health Systems/services | Social cultural/environmental/population health | Null | |
| Theme addressed 2 | ||||||
| Theme addressed 3 | ||||||
| Theme addressed 4 | ||||||
| Primary area of research (application form) | ||||||
| Primary area of research (authorization form) | ||||||
| Secondary area of research (application form) | ||||||
| Secondary area of research (authorization form) | ||||||
| Funding | ||||||
| Eligibility to hold CIHR funds | Already eligible | Had to apply with this application | Not eligible | |||
| If not eligible to hold CIHR funds, why not? | ||||||
| Funding amount applied for | $ | |||||
| Amount of CIHR funding granted | $ | |||||
| Name of other source of funding 1 | ||||||
| Amount of other source of funding 1 | $ | |||||
| In-kind contribution 1 | $ | |||||
| Name of other source of funding 2 | ||||||
| Amount of other source of funding 2 | $ | |||||
| In-kind contribution 3 | $ | |||||
| Decision Details - Grant Notice of Decision Form | ||||||
| Date of Decision | ||||||
| Scientific merit rating | ||||||
| Potential impact rating | ||||||
| Final rating | ||||||
| Application rank within the competition | ||||||
| Number in the competition | ||||||
| Approved for funding | Yes | No | ||||
| Scientific Officer Notes | ||||||
| Summary of evaluation by committee | ||||||
| Organization holding funds | Academic | Community | ||||
| Project start date | ||||||
| Project end date | ||||||
| Ethics approval obtained | Yes | No | ||||
| Ethics granting institution | ||||||
| Summary of evaluation by committee | ||||||
| Issues with the application process | ||||||
| Issues with academic/researcher CV | ||||||
| Issues with community CV | ||||||
| Other issues | ||||||
| Issues with funding process | ||||||
| Issues with ethics review | ||||||
| Other issues | ||||||
| Other issues | ||||||
| Performance Measurement | ||||||
| Number of interim/progress reports | ||||||
| Final Report | Yes | No | ||||
| Were the objectives in the application and final report consistent | Yes | No | Can't determine | |||
| Were the expected outcomes reported in the application and final report | Yes | No | Can't determine | |||
| Were the expected outcomes linked to specific objectives? | Yes, all | Yes, some | No | Can't determine | ||
| Did final report address whether objectives in application were met? | Yes, all | Yes, some | No | Can't determine | ||
| Did final report indicate whether expected outcomes were achieved | Yes, all | Yes, some | No | Can't determine | ||
| Project Details | ||||||
| Intended objectives | ||||||
| Intended activities | ||||||
| Intended outputs | ||||||
| Intended outcomes | ||||||
| Activities 1 (i.e., hosted conference) | ||||||
| Outputs 1 (i.e., 200 participants in conference | ||||||
| Outcomes 1 (i.e., capacity building, dissemination of results, communities used research results | ||||||
| Activities 2 | ||||||
| Outputs 2 | ||||||
| Outcomes 2 | ||||||
| Activities 3 | ||||||
| Outputs 3 | ||||||
| Outcomes 3 | ||||||
| Activities 4 | ||||||
| Outputs 4 | ||||||
| Outcomes 4 | ||||||
| Did the project experience difficulties meeting its objectives? | Yes, all | Yes, some | No | Can't determine | ||
| Describe any difficulties | ||||||
| Conclusion | ||||||
| Description of future planned activities | ||||||
| Description of difficulties reviewing this file | ||||||
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