Language Access Bridge Funding Application

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Language Access Bridge Funding- Applications (Intake)

Language Access

Bridge Funding Application

Employee Information

Primary contact first name *

Primary contact last name *

Primary contact UW email *

*Note: The application can be saved once the primary contact email is entered, generating an editable link sent to that email.

Is the primary contact also the principal investigator (PI)? *

Yes

PI first name *

PI last name *

PI UW email *

PI's primary college/school appointment *

Is this research associated with a research center? *

Yes

Please select which research center *

Other research center name (please specify)

Has the PI previously received funding through this award? *

Yes

Project Information

ClinicalTrials.gov ID *

What phase is the clinical trial in? *

Phase I

Phase II

Phase III

Phase IV

N/A

What is the focus of the clinical trial? *

Behavioral therapy

Digital health intervention

Drug intervention

Medical device intervention

Preventive care strategies

Surgical procedure

HSD study number *

Does your study have IRB approval? (approval is required for submission) *

Yes

This application requires IRB approval. Please return once approval has been granted.

IRB approval date *

Upload IRB approval document *

Maximum file size: 104.86MB

Approval date must be today or earlier.

Study title (same as IRB) *

Type of funding *

Industry sponsored (i.e., pharmaceutical/commercial sponsor)

Federally sponsored

Non-Federally sponsored (e.g., private foundation, gifts, etc.)

N/A (unfunded)

Name of funding organization *

Reason/justification for requesting funds for translations *

Other justification (if selected above) *

Language Access Information

Please complete a separate entry, using the "Add another services request" at the bottom of this section for each service (i.e., communication access real-time translation CART, interpretation, translation) you plan to request.

Service requested *

Type of interpretation service *

Video

Telephone

In-person

Target language(s) for translation/interpretation *

Purpose of translation/interpretation (select all that apply) *

Recruitment materials/process

Consent materials/process

Study visit procedure & process materials/process

Follow-up materials/process

Other

Other translation/interpretation purpose *

Target audience/demographic (e.g., age, gender, community, etc.) *

Funding amount requested for this service *

Target date for using funds? (within next 30 days) *

Target use date cannot be before today's date.

Have you considered any cultural factors to help ensure the message is respectful and accessible to the community? If so, what kinds of considerations have you made or would you consider? If not, what support would you need to ensure these considerations are considered? *

Would you consider working with cultural consultants or community members to review translations? If you’ve done this before, how did it go? *

How do you anticipate these materials supporting inclusion of broader communities? (impact & benefit) *

Vendor Information

Is this a contracted vendor in the UW Medicine System? *

Yes

Vendor name *

Vendor name (organization) *

Language access service provided *

Vendor contact first name *

Vendor contact last name *

Vendor contact email *

Vendor contact phone number *

Quote(s) *

Maximum file size: 104.86MB

Add another service request Remove

Total funds requested

Total requested must be at or below $5,000.

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