Section
Study Title
Insert here
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Principal Applicant Information
Name of Principal Applicant
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Primary institution, department and/or faculty
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Email Address
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Are you a CanVECTOR member?
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Select a value Yes No
Co-Applicant Information
List all co-applicants, including 1) Name, 2) Career Level, 3) Role, 4) Primary Institution
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Pilot study start date (yyyy/mm/dd):
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Pilot study end date (yyyy/mm/dd):
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Pilot Study Budget
Total budget requested (CAD):
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Institution to manage awarded funds
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Pilot Study Design
Does the proposed pilot study involve prospective randomization of patients to two or more interventions?
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Select a value Yes No
If you answered no to the previous question, describe the study design and confirm that the purpose of the pilot study is to evaluate the feasibility of a future randomized controlled trial by addressing issues of uncertainty
Patient Engagement
How will a Patient Partner participate on your study team? Specify their proposed roles and your engagement plan
Equity, Diversity, and Inclusion (EDI)
How will EDI be considered for the pilot study? (Max 200 words)
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Sex and Gender
How will Sex and Gender be considered for the pilot study? (Max 200 words)
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Knowledge Translation
Describe your strategy for integrated KT (Max 200 words)
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Pilot Proposal (maxiumum 4 pages)
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References
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Lay summary (maximum 1 page)
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Budget and budget justification (maximum 2 pages: spreadsheet + justification)
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I certify that the information in this application is complete and true, and I will provide supporting evidence as required.
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Select a value Yes No
