NAACCR Grant Application Form – Linkage with NCCR using Virtual Pooled Registry (VPR)

Sample Testing Version

Congratulations! Your registry has qualified for the opportunity listed below.

Linkage with NCCR using the Virtual Pooled Registry (VPR):
(Grant/Award: Funding TBD): To perform annual VPR linkage with the NCCR to help identify subsequent primaries within the NCCR cohort. Deliverables include the following:

Participate in annual VPR linkage between your full registry file and the NCCR cohort file to identify subsequent primaries
Utilize the VPR system and standard protocol for linkage using Match*Pro
Perform manual adjudication of possible matches
Submit data to IMS for incorporation into the NCCR

1. Start Date of Proposed Grant/Award: *This question is required. This question requires a valid date format of MM/DD/YYYY.

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2. End Date of Proposed Grant/Award: *This question is required. This question requires a valid date format of MM/DD/YYYY.

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Applicant Information

3. Program Contact Full Name: *This question is required.

4. Program Contact Position/Title: *This question is required.

5. Program Contact Email: *This question is required. This question requires a valid email address.

6. Program Contact Telephone #: *This question is required.

7. Financial/Administrative Main Contact Full Name: *This question is required.

8. Financial/Administrative Main Contact Email: *This question is required.

9. Financial/Administrative Main Contact Telephone #: *This question is required.

10. Applying Institution/Organization Name: *This question is required.

11. Institution/Organization Type (options included University/Academic, State/Provincial Central Cancer Registry, Other (write in required): *This question is required.

12. Institution/Organization, Complete Mailing Address: *This question is required.

Application Narrative
Instructions: All applicants are required to submit a single application that includes the information requested below.

13. Proposed Plan: Summarize your plan to complete the grant activities and meet the deliverables. Include information about who is responsible for each part of the plan and each deliverable (2-pages maximum) *This question is required.

14. Proposed Timeline: Provide a timeline of when grant activities and deliverables will occur (1-page maximum) *This question is required.

Registry Commitment

I attest that the registry intends to meet the deliverables according to this grant/award opportunity and as detailed in the proposed project plan/timeline *This question is required.

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Signature of

NAACCR Grant Application Form – Linkage with NCCR using Virtual Pooled Registry (VPR)

Grant /Awards