iTrace Foundation, Inc.

Grant Submission form

Please complete the following form in its entirety. Incomplete submissions will not be accepted.

If it is necessary to mail additional materials, please use the following address:

Meaghan Kirby
Administrative Director
iTrace Foundation, Inc.
8201 Peters Road. Suite 1000
Plantation, FL. 33324

• Organization & Contact Information

• Proposed Research Title
• Name of Organization
• Legal Entity
• President / Executive Director*
• Principal Investigator
  First Name Last Name
• E-mail
• Phone Number
  - Area Code Phone Number
• Grant Submission Contact
• E-mail
• Phone Number
  - Area Code Phone Number
• Website
• Address

  Street Address
  Street Address Line 2
  City	State / Province
  Postal / Zip Code	Please Select United States Abkhazia Afghanistan Albania Algeria American Samoa Andorra Angola Anguilla Antigua and Barbuda Argentina Armenia Aruba Australia Austria Azerbaijan The Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bermuda Bhutan Bolivia Bosnia and Herzegovina Botswana Brazil Brunei Bulgaria Burkina Faso Burundi Cambodia Cameroon Canada Cape Verde Cayman Islands Central African Republic Chad Chile People's Republic of China Republic of China Christmas Island Cocos (Keeling) Islands Colombia Comoros Congo Cook Islands Costa Rica Cote d'Ivoire Croatia Cuba Cyprus Czech Republic Denmark Djibouti Dominica Dominican Republic Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Ethiopia Falkland Islands Faroe Islands Fiji Finland France French Polynesia Gabon The Gambia Georgia Germany Ghana Gibraltar Greece Greenland Grenada Guam Guatemala Guernsey Guinea Guinea-Bissau Guyana Guyana Haiti Haiti Honduras Hong Kong Hungary Iceland India Indonesia Iran Iraq Ireland Israel Italy Jamaica Japan Jersey Jordan Kazakhstan Kenya Kiribati North Korea South Korea Kosovo Kuwait Kyrgyzstan Laos Latvia Lebanon Lesotho Liberia Libya Liechtenstein Lithuania Luxembourg Macau Macedonia Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Mauritania Mauritius Mayotte Mexico Micronesia Moldova Monaco Mongolia Montenegro Montserrat Morocco Mozambique Myanmar Nagorno-Karabakh Namibia Nauru Nepal Netherlands Netherlands Antilles New Caledonia New Zealand Nicaragua Niger Nigeria Niue Norfolk Island Turkish Republic of Northern Cyprus Northern Mariana Norway Pakistan Palau Palestine Panama Papua New Guinea Paraguay Peru Philippines Pitcairn Islands Poland Portugal Transnistria Pridnestrovie Puerto Rico Qatar Romania Russia Rwanda Saint Barthelemy Saint Helena Saint Kitts and Nevis Saint Lucia Saint Martin Saint Pierre and Miquelon Saint Vincent and the Grenadines Samoa San Marino Sao Tome and Principe Saudi Arabia Senegal Serbia Seychelles Sierra Leone Singapore Slovakia Slovenia Solomon Islands Somalia Somaliland South Africa South Ossetia Spain Sri Lanka Sudan Suriname Svalbard Swaziland Sweden Switzerland Syria Taiwan Tajikistan Tanzania Thailand Timor-Leste Togo Tokelau Tonga Trinidad and Tobago Tristan da Cunha Tunisia Turkey Turkmenistan Turks and Caicos Islands Tuvalu Uganda Ukraine United Arab Emirates United Kingdom Uruguay Uzbekistan Vanuatu Vatican City Venezuela Vietnam British Virgin Islands US Virgin Islands Wallis and Futuna Western Sahara Yemen Zambia Zimbabwe Other Country

• Organizational Budget for current fiscal year
• Estimated cost of project
• Amount sought from iTrace
• Project timeframe

• Proposed project Information

• Investigator
• Investigator (additional)
• Specific Aims

• Background & Significance

• State of existing knowledge regarding proposed research
• What audiences will be impacted

• Methodology

• Research location
• Anticipated research population
• How is the population above relevant to the research
• Will compensation be offered to participants? If yes, please explain.

• Data Collection & Analysis

• Research Overview
• Will you be accessing data from another party?
• Confidentiality maintenance
• How will you evaluate and analyze the results
• How will the data be used beyond this study
• How and to whom will the results of the project be disseminated

• Sustainability/Sources of future support

• Project Budget
• List of organizations board of directors, trustees, or officers
• Resume(s) and/or curriculum vitae for all principal investigators
• Questionnaire/interview questions for data gathering

• Terms & Conditions

• My organization is in compliance with the Affirmative Action/EEO requirements set forth in the sample grand agreement
  Yes No
• The grant submission contact has the authority to submit this grant on behalf of the organization
  Yes No
• Submit Form
• Should be Empty: