Group Psychotherapy Foundation Research Grant Application

Group Psychotherapy Foundation
Research Grant Application

Please print application before completing

Project Title: _________________________________________________

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Total Funds Requested: _______________________________________

Principal Investigator: _________________________________________

Current Position(s) of Principal Investigator: ______________________

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Mailing Address of Principal Investigator: _________________________

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Telephone Number of Principal Investigator:

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FAX Number of Principal Investigator:

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Co-investigator(s): _{________________________________________________}

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Institutional Location of Project: _______________________________

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Name and Address of Financial Officer who will administer the funds:

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Have funds for this project been obtained from other sources?

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Source(s): Amount: __________________________________________

I accept the conditions governing the award of a research grant as determined by the Group Psychotherapy Foundation.

Date: ______________________

Signature of Principal Investigator: ______________________________