TCC Shark Tank Submission

Submission Deadline (extended): Monday, April 10, 2017; 5:00 pm EST

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Applicant Information

First Name *

Last Name *

Credentials (PhD, MD, EdD, etc) *

Title/Job Position *

Institution/Organization Name *

Street Address *

City *

State *

Zip Code *

Email Address *

Phone Number *

Organization's nine-digit DUNS Number (e.g. Morehouse School of Medicine DUNS is 102005451) *

What is a DUNS Number?:

A Data Universal Numbering System (DUNS) number is a unique nine-digit identification number for each physical location of your business or organization. D-U-N-S Number assignment is free for all businesses required to register with the federal government for contracts or grants. For more information on DUNS numbers click HERE

To be eligible for funding through the TCC, all applicants must 1) submit a valid nine-digit DUNS Number; and 2) have their DUNS number verified in good standing with no delinquent government debt.

Project Information

Award Type *

Dissemination Award ($7,500.00)

Name of Project *

Project Co-investigators or Collaborators (Name, organization) *

Have you registered for the TCC Summit on May 4, 2017?

All Shark Tank applicants must register for the Summit to participate in Shark Tank. If you have not registered, please visit the TCC Summit website and register now: http://www.morehousetcc.org/Summit2017

YES

Submit Your Project Abstract/Summary

Please write a brief abstract or summary for your proposed project. Word limit is 250 words. If selected for the Shark Tank, your abstract and a high resolution photo will be added to the TCC Summit program guide. *

0/250 words

About Your Organization

Please submit a brief description of your organization/department/center/institute (100 words max) *

0/105 words

Submit Your Concept Paper

Upload your Shark Tank Concept Paper here. The maximum page limit is 2 pages, single spaced, minimum 11 pt. font, 0.5" margins (not including references). You may include one (1) reference document or appendix item.

Concept Paper *

Reference/Appendix Item *

Submit Your Abbreviated Budget

Upload your abbreviated budget and justification page(s). Budget should not exceed $7,500.00. You may access budget page templates on the TCC Summit 2017 website: http://www.morehousetcc.org/Summit2017.

Budget and Justification *

Terms and Conditions

I declare that all information provided in this submission is truthful to the best of my knowledge.

I understand that I am submitting my concept paper as part of a competitive process. I understand that I may or may not be selected as a Shark Tank candidate.

I understand that if I am selected as a candidate, I must respond to the invitation in a timely manner and make all necessary accommodations to attend the Summit in person and prepare for the Shark Tank. Failure to comply may result in a forfeiture of my invitation to participate in Shark Tank.

If I am selected as a Shark Tank winner, I must fully comply with all additional application requirements within the agreed upon time frame. Failure to complete deliverables in a timely manner may result in the withdrawal of my application.

I understand that all funding is contingent on the favorable review and approval of my full application by TCC's funding agency (National Institute on Minority Health and Health Disparities - NIMHD).

I understand that upon the final approval of my application, I will be asked to review and sign a Research Subaward Agreement to complete a dissemination project and participate in TCC Pilot Project Program capacity building activities. *

I agree to these terms and conditions

THANK YOU FOR ENTERING THE TCC SHARK TANK! Best of luck!

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