AQUATIC PHYSICAL THERAPY SECTION

AMERICAN PHYSICAL THERAPY ASSOCIATION

 

SPORTS AND ORTHOPEDIC RESEARCH GRANT APPLICATION
COVER SHEET

*Available to Aquatic Physical Therapy Section Members only*

(Developed June 2006)

 

Title of Proposed Study:

Name of Principle Investigator:

Professional Credentials:

Mailing Address:

Work Place:

APTA Membership Number:

Member of Aquatic Physical Therapy Section?   (Yes or No)

Email Address:

Daytime Telephone Number:

Daytime Fax Number:

Name of Co-Investigators and their role in the Study (for students list your committee members as co-investigators)

Name of Co-Investigator:

Role:

Name of Co-Investigator:

Role:

Name of Co-Investigator:

Role:

Name of Co-Investigator:

Role:

Is the Proposal for a Master’s Thesis or Doctoral Dissertation?*

_____  Yes

_____  No

*  Grant applications that are being requested to support a graduate student’s research must have written approval of the student’s graduate committee and advisor prior to grant submission.

Signature of Committee Advisor

If awarded grant, please identify who the check is to be made payable and mailing address:

Make Check payable to:

Complete Address:

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