Regional Connections Application

PRIM&R advances the highest ethical standards in the conduct of biomedical and social science/behavioral research. We accomplish this mission through education, membership services, professional certification, and public policy initiatives. The Regional Connections program is designed to facilitate connections between our members to help you build your regional community and further your professional development.

Please complete this application to be considered for funding. Applications are accepted on a rolling basis until all funds has been distributed. If you have any questions or need assistance completing the application or planning your event, please contact us at 617.303.1875, or email us at membership@primr.org.

Thank you for your interest in conducting a PRIM&R Regional Connections event.

Are you a resident of Canada, the European Union (EU), or the European Economic Area (EEA)? *This question is required.

In accordance with Canada's Anti-Spam Law and the General Data Protection Regulation, by checking yes, you are providing express consent for PRIM&R to collect the data you provide and to receive messages from PRIM&R regarding the Regional Connections program. You can withdraw your consent at any time by writing to us at 20 Park Plaza, Suite 1421, Boston, MA or via emai at privacy@primr.org.

1. Organization Information

Name of organization: *This question is required.

Type of organization: *This question is required.

Primary contact name: *This question is required.

Primary contact email: *This question is required.

PRIM&R member sponsor (if different from above):

How did you hear about PRIM&R Regional Connections? *This question is required.

2. Event Information

What type of event are you planning? *This question is required.

Networking reception
Book group
Brown bag lunch
Lecture
Policy Discussion
Educational program or conference
Other - Write In Please enter an 'other' value for this selection.

Title of event: *This question is required.

Date of event: *This question is required.

Location of event: *This question is required.

Principal planners: *This question is required.

Intended audience and estimated size: *This question is required.

Please provide a brief description, as well as the proposed agenda, for the event. You may upload the agenda in the space below. *This question is required.

3. You may upload your agenda here.

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4. Please describe your reasons for seeking funding from PRIM&R and the anticipated benefit to PRIM&R members that your event will offer: *This question is required.

5. A core value of PRIM&R is the diversity of people, ideas, and opinions. For applicants within the United States: Do you have plans to conduct targeted outreach to Historically Black Colleges and Universities (HBCUs), Tribal Colleges and Universities (TCUs), and Hispanic-Serving Institutions (HSIs) in your region? *This question is required.

If you would like more information on reaching diverse audiences through your event, please contact the PRIM&R staff at membership@primr.org.

7. The purpose of the Regional Connections program is to facilitate connections between our members, help you build your regional community, and further your professional development. How does your proposal meet these three objectives? *This question is required.

8. Please list below any relevant programs, brochures, or other publicity that will include the PRIM&R name. If these are not available at the time of this request, please list below along with the anticipated date of availability and provide them when they become available. *This question is required.

9. You may upload relevant marketing materials here if they are available.

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10. Primary funding source(s) or co-sponsors for event: *This question is required.

11. Amount of funding requested from PRIM&R:
The amount should not exceed $1,000. Events must offer demonstrable benefits to PRIM&R members. Please itemize projected expenses for the amount requested. All grants are designated for support of direct costs incurred by the educational event. It is PRIM&R's policy not to pay overhead. *This question is required.

13. Does this event include a registration fee for attendees? If yes, how much are the fees? How much do you anticipate you will raise from fees? What expenses will the fees underwrite? *This question is required.

14. Restrictions/conditions:
Please list any conditions or restrictions any co-sponsoring entities may impose on program development. *This question is required.

Disclosure of conflict of interest:
Individuals involved in planning and implementing a PRIM&R Regional Connections event are expected to avoid conflicts of interest that have the potential to: (i) directly and significantly affect PRIM&R's interests, (ii) compromise objectivity in carrying out their responsibilities to PRIM&R, or (iii) impact the integrity and quality of the services and products provided by PRIM&R. The term "conflict of interest" refers to situations in which financial or other personal considerations may directly and significantly affect an individual's professional judgment in exercising his or her duties. Not all conflicts of interest are impermissible, but individuals have a responsibility to examine, disclose, and manage any activity, commitment, or action, which might constitute a conflict of interest.

15. Please list any conflicts below. For more information on PRIM&R’s conflict of interest policy, please contact us. *This question is required.

Summary report/itemization of expenses/attendance list:
If your program is accepted for funding, the following items should be submitted within 60 days of the event’s conclusion:
• A summary report, suitable for inclusion in the PRIM&R Member Newsletter, along with a photo of the PRIM&R member sponsor. You are welcome to include photos of the event as well.
• If applicable, a summary of the event evaluations.
• An itemization of actual expenses for the amount granted.
• An attendance list (include name, institution, mailing address, and email address).