Grants ICT Form for Healthcare 2014

1. Information Collection Tool (ICT)

The more complete & comprehensive information you can provide in this form, the more targeted and effective the research will be. The target turnaround time for a response is 10 days from submission.

Please send questions to
1. Organization Name
2. Contact Name & Title
3. Contact Information
4. Contact Mailing Address
5. Info to assist with grants analysis:

Think about the following when completing the questions below regarding Project Goals:

• How will patient safety change for the better?
• Why will the project advance the training of healthcare personnel
• How will patient monitoring or transfer of records be enhanced
• What are the benefits to patients? Doctors?
• How will it improve efficiencies and service within the hospital?

6. Project Goal(s): Why are you seeking grant funding?

*Purpose for funding
*Briefly describe your top priorities
*What problem does your project hope to address?
7. Project Overview:
*How does your organization intend to use the grant funding to achieve this goal(s)?
(i.e., brief project description, actions to be taken, products to be secured, etc.)
8. Does the project have the approval of the organization's lead executive?
9. Does your organization employ a grant writer?
10. Is your organization currently seeking or approved for funding for this or a similar project?