Submitting an Online Application for the 2018 Foundation Quality Improvement Award

Applications for the 2018 QI Award will be accepted until November 17, 2017.

Please read the following section on Documents You'll Need so that you can complete these items and have them ready on your computer before you begin filling out the application.

Documents You'll Need to Include with Your Submission

The following documents need to be submitted with your application. Please complete them before beginning your submission making note of where on your computer you've placed them as the application form will ask you to browse and selected these files.

  • Applicant's Curriculum Vitae: Your curriculum vitae;
  • Facility Administrator's Sponsorship Letter: The sponsorship letter from the facility administrator where project will be conducted must be signed by the facility medical director if the applicant is not a medical director. The letter should affirm the facility’s commitment to the project, his/her willingness to support your involvement in this project, and his/her agreement to disperse funds in accordance with the award guidelines outlined in the program brochure. If the applicant is not a medical director, please have the facility’s medical director also sign the facility administrator letter.
  • AMDA Member Sponsorship Letter: A sponsorship letter from an AMDA member sponsoring the application is necessary if the applicant is not an AMDA member. The letter should address the sponsor's level of involvement in the project.
  • Foundation QI Awards Project Proposal: This document includes the objectives, research design, methodology, and expected performance outcomes of your proposal. A ready made form, which you can fill out and submit with your application can be downloaded from the following link:

    Foundation QI Awards Project Proposal

  • Foundation QI Awards Detailed Budget: This document addresses justification for expenses, including materials, travel to tAMDA-The Society's 2018 annual conference ($1,500), and in-kind support from the facility (if any). A ready made form, which you can fill out and submit with your application can be downloaded from the following link:

    Foundation QI Awards Detailed Budget

The above documents should be one of the following types: MS Word (doc or docx); PDF (pdf); MS Excel (xls or xlsx); MS Powerpoint (ppt or pptx); Text (txt); and ZIP (zip). The maximum file size for any document submitted with your application must not exceed 6,144 KB in size (6 megabytes).

Please contact us if you need any assistance with creating and uploading your documents.

Internet Explorer Users:

We recommended that you submit our forms using a modern compliant browser such as an up-to-date version of Chrome, Firefox, or Safari and avoid using MS Internet Explorer, especially older versions, which present some compatibility problems.

2018 Quality Improvement Award - Online Application Form

Applicant's Information

Page 1 of 6

The information on this page pertains to the applicant's information.

First Name(*)
Please provide your full name.

Last Name(*)
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Credentials(*)
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Please list credentials separated by commas.

Title / Position(*)
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Institution / Facility
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Address(*)
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City(*)
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State(*)
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Zip(*)
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Phone(*)
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E-mail(*)
Invalid email address.

Curriculum Vitae (CV)(*)
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Please upload a current copy of your Curriculum Vitae in one of the following file formats: doc, .docx, pdf, txt.

 

Project Information

Page 2 of 6

The information on this page pertains to your project proposal.

Project Title(*)
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Therapeutic Area(*)
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Example: pain management, dementia, urinary incontinence.

Project Category(*)

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Participant Facility
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Institution/facility where project will be conducted.

Address(*)
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City(*)
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State(*)
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Zip(*)
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Phone(*)
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Medical Director(*)
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Enter the name of the Medical Director for the Institution/Facility.

Facility Sponsorship Letter(*)
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Please upload the Facility Administrator's Sponsorship Letter in one of the following file formats: doc, .docx, pdf, txt.

 

Sponsorship Information

Page 3 of 6

The information on this page pertains to your sponsorship for this project.

AMDA Member(*)
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Select Yes if you are an AMDA member or associate member. Otherwise, select No.

AMDA Sponsorship Letter
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Please upload the AMDA Member Sponsorship Letter if you are NOT an AMDA member or associate.in one of the following file formats: doc, .docx, pdf, txt.

 

Human Subjects Research

Page 4 of 6

The information on this page pertains to activities involving human beings as research subjects.

Research Involving Human Subjects
Safeguarding the rights and welfare of human subjects involved in activities supported by the AMDA Foundation is the responsibility of the facility or organization that receives the funds awarded. In order to provide for the adequate discharge of this institutional responsibility, no grant for an activity involving human subjects shall be made unless the application for such support has been reviewed and approved by an appropriate facility or organizational committee.

Human Subjects Research(*)
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Select No if this application DOES NOT propose any activities that would involve human beings as research subjects.

Select Yes certifying that this application, if accepted, which does propose research activities involving human subjects, will be reviewed and approved by our facility/organizational committee in accordance with current DHHS policy. Certification is invalid if review date precedes date award is made, by more than 1 year.

 

Project Proposal

Page 5 of 6

The information on this page pertains to the project's proposal and detailed budget.

QI Project Proposal(*)
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Please upload the completed AMDA Foundation QI Awards Project Proposal form in one of the following file formats: doc, .docx, pdf, txt.

QI Detailed Budget(*)
Invalid Input

Please upload the completed AMDA Foundation QI Awards Detailed Budget form in one of the following file formats: doc, .docx, pdf, txt.

Total Expenses(*)
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Please enter the total expenses for the project proposal.

 

Validation Check

Page 6 of 6

The information on this page pertains to the security and validation of this submission.

Captcha(*)
Captcha   RefreshInvalid Input

Type the four lower case characters shown in the box above on the left into the box on the right and click Submit. You may click the Refresh link above as many times as you need to until you're confident you see the letters clearly.