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Anesthesia Patient Safety Foundation (APSF)

Acceptance of Conditions of Grant Form

(To be completed by applicant)

Name: ____________________________________________________________

I will acknowledge the award of this APSF grant in any publication presenting work that results from this grant support.

I agree to submit a written progress report six (6) months after the starting date of this project; this report will include major changes in the research plan, if any, and a summary of data collected to date.

I further agree to submit to APSF a written final report within two (2) months after the end of the grant period.

I will promptly notify the Chairman of the APSF Scientific Evaluation Committee of any abstracts, reports, manuscripts, or any other form of published information, e.g., CD-ROMs, book chapters, videos, or tapes that were supported in whole or in part by this APSF grant.

I will provide the Chairman of APSF Scientific Evaluation Committee with copies of such reports and/or published materials.

I will return any and all funds that are unused at the end of the study.

DATE: ________________ SIGNATURE: ____________________________
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APSF | Building One, Suite Two | 8007 South Meridian Street
Indianapolis, IN 46217-2922 | f. 317.888.1482
e. walker@apsf.org

Last updated: 02.07.2008

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