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BHI Impact Program Application
Instructions for Completing the Impact Program Application Form
The Impact Program application form is divided into the following four sections:
Required ApplicantsCo-ApplicantsCollaboratorsProject InformationWe recommend reviewing the full application form
ImpactGrants.pdf in advance to ensure you have all the required information and supporting documents ready.
Please note that the PDF form is provided for reference only; applications must be submitted electronically through
the designated online portal. PDF or email submissions will not be accepted.
If you are unable to complete the form in one session, you may use the "Save & Return Later" feature. To resume
your application later, please:
Click "Save & Return Later" at any time.Save your return code in a secure location.Bookmark the page you are
working on for easy access.
RESEARCH PROJECT TITLE
Research project title:
__________________________________
REQUIRED APPLICANTS
Please provide information on the Principal Applicant (Academic) , the Principal Knowledge
User, and Co-Applicant_ Academic
PRINCIPAL APPLICANT (Academic)
* must provide value
First name: ______
Last name: ______
Email address: ______
Institution/Organization: ______
______ ______
Title: ______
______ ______
Department: ______
Faculty: ______
Canada Research and Development Classification (CRDC) Code - Group Level ______
Is this applicant an early career researcher (i.e., within first 5 years of independent research appointment?): ______
Institution administering funding: ______
______ ______
Please upload the Principal Applicant's CV: ______
Principal Knowledge User
Knowledge users are people, including representatives of communities and organizations who are likely to use
research results to make informed decisions, or anybody who may benefit or be otherwise affected by research
results. This can include, but is not limited to patients, Indigenous leaders and communities, health professionals,
community-based organizations, health charities, health system leaders, policy-makers, and private sector
organizations.
* must provide value
First name: ______
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Email address: ______
Institution/Organization: ______
Sector/Type of organization: ______
Please upload the Principal Knowledge User's CV : ______
Co-Applicant_Academic
A BHI Core or Associate Academic Member eligible to hold Tri-Council research funding that is from a clearly distinct
research discipline than the Principal Applicant.
* must provide value
First name: ______
Last name: ______
Email address: ______
Institution/Organization: ______
______ ______
Title: ______
______ ______
Department: ______
Faculty: ______
Canada Research and Development Classification (CRDC) Code - Group Level ______
Is this applicant an early career researcher (i.e., within first 5 years of independent research appointment?): ______
Please upload the Co-Applicant_Academic's CV: ______
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BHI Impact Program Application_Co-Applicants
Please provide information for each Co-Applicant.
If there is more than one, click "Submit and add another Co-Applicant' after entering each one.
Once all Co-Applicants have been added, click 'Next Page' to proceed to the Collaborators section.
Co-Applicant
Do you want to add a co-applicant?
If you do not have any additional co-applicants to add, please select "No". When the pop-up message appears,
choose "End Survey" - this will automatically direct you to the next page.
Yes
No
Is this co-applicant a:
(If the co-applicant fits in more than one category, please select their primary role on this project)
Academic
Knowledge user
Patient Partner
Trainee
Knowledge users are people, including representatives of communities and organizations who are likely to use
research results to make informed decisions, or anybody who may benefit or be otherwise affected by research
results. This can include, but is not limited to patients, Indigenous leaders and communities, health professionals,
community-based organizations, health charities, health system leaders, policy-makers, and private sector
organizations.
Patient Partners are individuals with lived experiences with a health issue, informal caregivers (including family and
friends) and/or individuals that are at risk of, or otherwise, affected by brain-heart conditions.
First name:
__________________________________
Last name:
__________________________________
Position
Professor Emeritus
Full Professor
Associate Professor
Assistant Professor
Adjunct Professor
Other
Please specify other academic position:
__________________________________
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Position
Master's student
Doctoral student
Postdoctoral fellow
Other
Please specify other trainee position:
__________________________________
Institution/Organization:
University of Ottawa
University of Saskatchewan
McGill University
University of Ottawa Heart Institute
Institut du Savoir Montfort
Ottawa Hospital Research Institute
Bruyere Health Research Institute
The Royal's Institute of Mental Health Research
CHEO Research Institute
Other organization
Please specify other institution
__________________________________
Institution/Organization
__________________________________
Sector/Type of organization
Canadian Academic institution
Other Canadian research organization (including research hospitals)
Academic and research institutions abroad (including research hospitals)
Private sector in Canada
Private sector abroad
Public sector in Canada (e.g., health care, education)
Public sector abroad
Philanthropic/Not-for-Profit/Other in Canada
Philanthropic/Not-for-Profit/Other abroad
Not Applicable
Canada Research and Development Classification (CRDC) Code - Group Level
__________________________________
Is this applicant an early career researcher (i.e., within first 5 years of independent research appointment)?
Yes
No
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Is this an Indigenous organization?
Yes
No
Email address
__________________________________
Upload co-applicant's CV here
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BHI Impact Program Application_Collaborators
Please provide information for each collaborator.
If there is more than one, click "Submit and add another collaborator' after entering each one.
Once all collaborators have been added, click 'Next Page' to proceed to the Project Information section.
Do you want to add a collaborator?
If you do not have any additional collaborators to add, please select "No". When the pop-up message appears,
choose "End Survey" - this will automatically direct you to the next page.
Yes
No
Collaborator
First name: ______
Last name: ______
Institution/Organization: ______
Sector/Type of organization: ______
Is this an Indigenous organization? ______
Email address: ______
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BHI Impact Program Application_Project Information
Please provide the required information about your project.
BHI SCIENTIFIC FOUNDATIONS & THEMES
Please select the 1-3 most relevant Foundations or Themes
Foundation 1: Clinical & Epidemiology Research
Foundation 2: Basic Science & Discovery Research
Theme 1: Biomarkers & Imaging Tools
Theme 2: Therapeutics
Theme 3: Precision Prevention During the Lifespan
Theme 4: Innovative Health Systems & Tailored Models of Care
Other (please specify and explain):______
KEYWORDS
Please list 5-10 keywords associated with your project
* must provide value
1) ______
2) ______
3) ______
4) ______
5) ______
6) ______
7) ______
8) ______
9) ______
10) ______
PLAIN LANGUAGE PROJECT SUMMARY
Provide a plain language project summary (maximum 200 words)
CONTRIBUTION TO BHI
Contribution to BHI (maximum 300 words)
Describe how the project and activities relate to joint brain-heart health, including the specific brain and heart
conditions to be addressed. Describe how the project will contribute to the goals, objectives and deliverables of one
or more BHI Foundations, Themes or Cross-Cutting Themes.
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DESCRIPTION OF THE TEAM
Description of the team (maximum 500 words)
The description should include the following elements:
The interdisciplinary nature of the team, including expertise of academics, patients and other knowledge users. The
complementary knowledge and skills of members and the role and contribution of each. How IDEAS has been
considered in team composition. If relevant, the team's relationship and experience with Indigenous communities
and partners. Information on strategies that will be used to meaningfully involve knowledge users, patients and
partners, particularly from groups that are underrepresented in research.
DESCRIPTION OF THE PROJECT
Objectives (maximum 100 words)
Describe the research objectives as well as the research question(s) and/or study hypothesis
Background (maximum 300 words)
Provide background information and the rationale for the project, including review of relevant literature justifying the
need for the study and/or knowledge gaps.
Study Design & Analysis Strategy
Gender-based analysis plus (GBA+) is used to assess the potential impact that identity factors may have on the
experience of the individual. These considerations must be integrated into the research design, when appropriate.
Projects must adhere to Health Canada's Sex and Gender Based Analysis Plus Policy. Please answer the following
questions:
Is it appropriate to integrate GBA+ and Sex and Yes
Gender-Based Analysis (SGBA) considerations into the No
proposed research?
Is sex, as a biological variable and is gender, as a Yes
socio-cultural factor, considered in the research No
design, methods, analysis interpretation, and/or
dissemination of findings?
Are diversity/intersectionality considerations Yes
considered in the research design, methods, analysis, No
and interpretation, and/or dissemination of findings?
Will the Public Health Agency of Canada Strengthening Yes
of Intersectionality Theory in Health Inequalities No
Analysis (SIITHIA) checklist be used?
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If you answered "Yes" to some or all of the above, describe in your Study Design & Analysis Strategy (in text box
below) how sex and/or gender and their intersectionalities have been factored into the study design, data collection
and analysis of the project.
If you answered "No" to some or all of the questions above, describe why these elements are not incorporated into
the project (maximum 250 words)
Describe and justify the study design, research methods and data analysis strategy for the project. Describe IDEAS
(Inclusion, Diversity, Equity, Accessibility and Social Justice) considerations related to the research plan and analysis
including how sex, gender and intersectionality will be included in the study design, research methods and analysis.
(maximum 1400 words)
Co-Production & Knowledge mobilization plan (maximum 500 words)
The co-production and knowledge user engagement approach and extent to which knowledge user(s) will be
meaningfully engaged throughout the project. Potential risks to the project implementation and strategies to mitigate
the risks. Description of the knowledge mobilization plan and strategies to deliver impact beyond the scientific
community.
Indigenous Engagement
Does this project include the engagement of First Nations, Inuit and/or Métis people?
Yes
No
Describe the study team's relationship with Indigenous communities and partners, their experience partnering with
Indigenous communities and partners on research, decision-making processes to be used with Indigenous
communities and partners, local capacity building, etc. Describe how the project adheres to the First Nations
principles of ownership, control, access, and possession (OCAP Principles ®) (maximum 200 words)
Complete and upload the Indigenous Research Level of Engagement Tool (IRLET)
Justify why the project will not involve Indigenous engagement and the recruitment of Indigenous people (maximum
200 words)
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Data Management
Will the project adhere to the Findability, Accessibility, Interoperability, and Reuse (FAIR) Principles for scientific data
management and stewardship of digital assets?
Yes
No
Describe how the project will adhere to the FAIR Principles (maximum 200 words)
Justify why the project will not adhere to the FAIR Principles (maximum 200 words)
Commercialization
Do you see potential for commercialization of the findings?
Yes
No
Risk Mitigation (maximum 250 words)
Describe potential risks to the project and its implementation and strategies to mitigate the risks. Also consider
threats that may be related to implementing research coproduction approach, patient engagement, Indigenous
engagement, IDEAS, etc.
If applicable, please upload a document with any required tables or figures (maximum 1 page) and references
(maximum 1/2 page) related to your project description.
TRANSFORMATIONAL PLATFORMS
The BHI is supporting the following transformational platforms/core facilities. Please indicate those you plan to use as
part of this project:
Advanced Brain-Heart Optical Imaging Technologies
Brain-Heart Preclinical Imaging
Neurocognitive Testing
Ottawa Methods Centre
Office for Patient Engagement in Research Activities (OPERA)
Brain-Heart Surgery
Multiomics
Bioinformatics
Single-Cell Transcriptomics
Metabolomics Drug Screening
NeuroCardioAI
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OUTCOMES & IMPACT
Outcomes and impact (maximum 300 words)
Explain the project's impact pathway. How will the short-term catalytic support and resulting deliverables contribute
towards the BHI intermediate, long-term and ultimate outcomes? Nature of any partnerships, including cash and
in-kind contributions. Indicators of project success (qualitative and/or quantitative). At least one to demonstrate
equitable results.
Please upload letters of support :
Letter of support 1: ______
Letter of support 2: ______
Letter of support 3: ______
Letter of support 4: ______
Letter of support 5: ______
*If you have more than 5 letters of support, please merge the letters into one file for upload.
MILESTONES
Milestones (maximum 200 words)
Describe the overall timelines and major milestones of the project. The detailed milestone table in the budget
template is also to be completed.
BUDGET
Prepare a budget for the project, including the module for estimating costs associated with
patient engagement , if applicable. Please refer to the BHI Guidance for Patient/Community
Partner Compensation and Honoraria for Indigenous Elders. Co-funding from partners is
encouraged and must be included in the budget template, if applicable.
Please download the budget template for completion.
[Attachment: "BHI Budget Template Impact.xlsx"]
Upload the completed budget template here.
SUGGESTED REVIEWERS
Suggested reviewers
Please suggest three independent external reviewers (academics and/or knowledge users) for this project.
* must provide value
REVIEWER 1
First name: ______
Last name: ______
Faculty (if relevant): ______
Institution/organization: ______
Email address: ______
REVIEWER 2
First name: ______
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Last name: ______ projectredcap.org
Faculty (if relevant): ______
Institution/organization: ______
Email address: ______
REVIEWER 3
First name: ______
Last name: ______
Faculty (if relevant): ______
Institution/organization: ______
Email address: ______
REQUEST FOR FUNDS FORM (RE FORM)
RE Form: Applicants from the University of Ottawa are required to include Request for Funds form (RE Form)
completed and signed by all parties.
APPLICANT DECLARATION
On behalf of myself and any co-applicants, I declare that the information provided in this application is true and
accurate and will abide by the conditions described in this application package, and the rules of ethics for all
research involving humans or experimental animals.
By submitting this application, we consent to Brain-Heart Interconnectome representatives utilizing our email
addresses for the purpose of communications related to this application. We understand and agree that our email
addresses may be disclosed to other members of the BHI network or partner organizations as deemed necessary.
We consent to the information provided in the application being shared by email for the purpose of peer review
and/or evaluation. We acknowledge that BHI cannot guarantee the security of external systems through which email
messages may be transmitted and accept the risk associated with such transmissions.
