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 g19188@att.com.

* 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?