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TRAUMA AND DISASTER MANAGEMENT (TRADIM)

RESEARCH GRANTS

2017 APPLICATION FORM

1. SMALL GRANTS

2. PROJECT GRANT

CLOSING DATE: 5:00 pm Monday 8 August 2016

SMALL GRANTS ($20,000) provide seed funding for research studies that have the potential to build capacity. Applicants should demonstrate the potential for the research to improve health outcomes through evidence based practice. Two grants will be available.

The PROJECT GRANT ($50,000) provides stand-alone support for a defined project that demonstrates potential for the research outcomes to be translated into improved health outcomes through evidence based practice, and/or result in future national or international grants. One grant will be available.

Trauma and Disaster Management Research Grant Scheme Page i

APPLICATION INSTRUCTIONS

Refer to the Trauma and Disaster Management (TRADIM) Research Grant Funding Guidelines for funding commencing in 2017 document when preparing your application.

The application MUST be prepared using the supplied application form. Complete all sections as incomplete applications may not be considered.

Press <Tab> to move between fields.

The applicant is required to sign the application on behalf of the research team.

SUBMISSION

Applications must be submitted electronically to [email protected] :

1. A signed copy of the application to be submitted as a PDF,

2. The application must also be submitted in Word format (signatures not required).

Files must not exceed 2 MB in size and should be named using the following naming convention:

Applicant Surname_2017 TRADIM Funding type*

E.g., Smith_2017 TRADIM Small

*Funding types – Small, Project

APPLICATIONS MUST BE RECEIVED BY THE CENTRES FOR HEALTH RESEARCH

NO LATER THAN 5:00 PM MONDAY 8 AUGUST 2016

LATE OR INCOMPLETE APPLICATIONS WILL NOT BE ACCEPTED

ENQUIRIES

Enquiries regarding the TRADIM Research Grant Scheme should be directed to:

PAH Research Grants Administration Officer

Email: [email protected]

Trauma and Disaster Management Research Grant Scheme Page ii

mailto:[email protected]


TRADIM RESEARCH GRANTS

2017 APPLICATION FORMRESEARCH GRANT APPLICATION TYPE

Small Grant

Project Grant

PROJECT TITLE

(Maximum 200 characters including spaces)

INVESTIGATIVE TEAM

The Applicant must be the Principal Investigator (PI). Up to 4 Co-Investigators (CIs) and 2 Associate Investigators (AIs) may be included.

Title Name Health Profession Organisation

PI Click to choose First name Surname Click to choose Click to choose

CI1 Click to choose First name Surname Click to choose Click to choose




AI1 Click to choose First name Surname Click to choose Click to choose

AI2 Click to choose First name Surname Click to choose Click to choose

OFFICE USE ONLYAPPLICATION NUMBER:

TRADIM 2 0 1 7

Trauma and Disaster Management Research Grant Scheme Applicant:

ELIGIBILITY CHECKLIST

To be eligible for a 2017 TRADIM Small or Project Research Grant, the Applicant must be able to answer:

YES to questions 1-5

NO to question 6

YES NO

1 Are you a member of staff of Metro South Health, Royal Darwin Hospital or the NCCTRC?

2 Will you be employed in the above appointment at least 0.5 FTE for the duration of the grant?

3 Will the majority (more than 50%) of the research take place:

1. Within a Metro South Health Site?

2. At the Royal Darwin Hospital?

3. In a NCCTRC-approved partnership service facility or organisation within Queensland or the Northern Territory?

If iii, provide details of the NCCTRC-approved partner service facility or organisation in the space provided below.

4 Is at least one member of the investigative team a medical doctor, nurse or allied health professional?

5 Does the investigative team contain a member of staff from Metro South Health Service OR the Royal Darwin Hospital or NCCTRC?

6 Is the proposed research activity currently funded through an award type currently listed on the Australian Competitive Grants Register or international equivalent?

Details of NCCTRC-approved partner service facility/organisationIf you answered YES to Question 3iii above, provide details of the NCCTRC-approved partnership service facility or organisation including location, who approved the service facility/organisation and when it was approved (maximum 300 characters including spaces).

Eligibility CertificationI, [First Name, Surname], certify that I meet the relevant eligibility criteria for the TRADIM Research Grant Scheme.

Signature of Applicant: _____________________________________________ Date:

If you have questions concerning your eligibility for the TRADIM Research Grant Scheme, contact

PAH Research Grants Administration Officer

Email: [email protected]

TRADIM Research Grant Application Page 2



1. PRINCIPAL INVESTIGATOR (APPLICANT)

1.1. PI CONTACT DETAILS

PI name Click to choose First Name Surname

Position

Organisational Department

Department name

Phone numbers Primary: Secondary:

Email address

Postal Address Address line 1

Address line 2

Address line 3

Suburb and Postcode

1.2. PI ACADEMIC QUALIFICATIONS

Qualification Awarding Institution Date DD/MM/YEAR

DD/MM/YEAR

DD/MM/YEAR

DD/MM/YEAR

1.3. PARTICIPATIONSummarise your participation in the broad research plan proposed in this application (maximum 300 characters including spaces)

1.4. PI RESEARCH TIME

Expected 2016 time allocation to:

This study (hr/wk): Other studies (hr/wk):

Do you expect to have an extended period of absence during 2016?

Yes No

If Yes, provide expected dates DD/MM/YEAR - DD/MM/YEAR

Reason(300 characters including spaces)

1.5. PI PUBLICATIONSList publications produced in the last 5 years with List ALL authors provided

Indicate publications relevant to this application with an asterisk (*)

Press <Enter> after each publication to maintain the numbering system

1.

1.6. PI GRANTSProvide details of research funding received in the last 5 years and indicate whether the funding relates to the proposed research of this application



If there is insufficient space in the below table just include the most relevant grants to this application.

Funding body and type Start dateEnd date

Amount Relevant to this application?

[DD/MM/YYYY]

[DD/MM/YYYY]

$ Yes

No

[DD/MM/YYYY]

[DD/MM/YYYY]

$ Yes

No

[DD/MM/YYYY]

[DD/MM/YYYY]

$ Yes

No

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$ Yes

No

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$ Yes

No

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No

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$ Yes

No

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No

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No

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$ Yes

No

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$ Yes

No

[DD/MM/YYYY]

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$ Yes

No

[DD/MM/YYYY]

[DD/MM/YYYY]

$ Yes

No



2. CO-INVESTIGATOR 1

2.1. CI1 CONTACT DETAILS

CI1 Name Click to choose First Name Surname

Position

Organisation and Department

Organisation and Department name

Phone number

Email address

2.2. CI1 ACADEMIC QUALIFICATIONS

Qualification Institution Date DD/MM/YEAR

DD/MM/YEAR

DD/MM/YEAR

DD/MM/YEAR

2.3. CI1 PARTICIPATIONSummarise the role of CI1 in the broad research plan proposed in this application (maximum 300 characters including spaces)

2.4. CI1 RESEARCH TIME



Does CI1 expect to have an extended period of absence during 2016?

Yes No



2.5. CI1 PUBLICATIONSList CI1 publications produced in the last 5 years with List ALL authors provided



1.

2.6. CI1 GRANTSProvide details of research funding received by CI1 in the last 5 years and indicate whether the funding relates to the proposed research of this application




Funding body and typeStart dateEnd date

Funding Amount

Relevant to this application?

[DD/MM/YYYY]

[DD/MM/YYYY]

$ Yes

No

[DD/MM/YYYY]

[DD/MM/YYYY]

$ Yes

No

[DD/MM/YYYY]

[DD/MM/YYYY]

$ Yes

No

[DD/MM/YYYY]

[DD/MM/YYYY]

$ Yes

No

[DD/MM/YYYY]

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$ Yes

No

[DD/MM/YYYY]

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$ Yes

No

[DD/MM/YYYY]

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$ Yes

No

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No

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No






Position



Phone number

Email address



DD/MM/YEAR

DD/MM/YEAR

DD/MM/YEAR






Yes No






1.






Funding Amount


[DD/MM/YYYY]

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No

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No

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No

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No

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No






Position



Phone number

Email address



DD/MM/YEAR

DD/MM/YEAR

DD/MM/YEAR






Yes No






1.






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[DD/MM/YYYY]

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$ Yes

No

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No

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$ Yes

No

[DD/MM/YYYY]

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$ Yes

No

[DD/MM/YYYY]

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No

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No

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No

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No

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[DD/MM/YYYY]

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$ Yes

No






Position



Phone number

Email address



DD/MM/YEAR

DD/MM/YEAR

DD/MM/YEAR






Yes No






1.






Funding Amount


[DD/MM/YYYY]

[DD/MM/YYYY]

$ Yes

No

[DD/MM/YYYY]

[DD/MM/YYYY]

$ Yes

No

[DD/MM/YYYY]

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$ Yes

No

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$ Yes

No

[DD/MM/YYYY]

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$ Yes

No

[DD/MM/YYYY]

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$ Yes

No

[DD/MM/YYYY]

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$ Yes

No

[DD/MM/YYYY]

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$ Yes

No

[DD/MM/YYYY]

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$ Yes

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$ Yes

No

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$ Yes

No

[DD/MM/YYYY]

[DD/MM/YYYY]

$ Yes

No

[DD/MM/YYYY]

[DD/MM/YYYY]

$ Yes

No

[DD/MM/YYYY]

[DD/MM/YYYY]

$ Yes

No

[DD/MM/YYYY]

[DD/MM/YYYY]

$ Yes

No

[DD/MM/YYYY]

[DD/MM/YYYY]

$ Yes

No

[DD/MM/YYYY]

[DD/MM/YYYY]

$ Yes

No

[DD/MM/YYYY]

[DD/MM/YYYY]

$ Yes

No



6. ASSOCIATE-INVESTIGATOR 1

6.1. AI1 CONTACT DETAILS

AI1 Name Click to choose First Name Surname

Position



Phone number

Email address

6.2. AI1 ACADEMIC QUALIFICATIONS


DD/MM/YEAR

DD/MM/YEAR

DD/MM/YEAR

6.3. AI1 PARTICIPATIONSummarise the role of AI1 in the broad research plan proposed in this application (maximum 300 characters including spaces)



7. ASSOCIATE-INVESTIGATOR 2

7.1. AI2 CONTACT DETAILS

AI2 Name Click to choose First Name Surname

Position



Phone number

Email address

7.2. AI2 ACADEMIC QUALIFICATIONS


DD/MM/YEAR

DD/MM/YEAR

DD/MM/YEAR

7.3. AI2 PARTICIPATIONSummarise the role of AI2 in the broad research plan proposed in this application (maximum 300 characters including spaces)



8. RESEARCH PROPOSAL

8.1. KEY WORDSProvide up to keywords that best describe the field of research

Keyword 1 Keyword 2 Keyword 3

Keyword 4 Keyword 5 Keyword 6

8.2. AIMS & HYPOTHESIS(Maximum 1,000 characters including spaces)

8.3. RESEARCH SIGNIFICANCEDescribe the expected outcomes and benefits of the proposed study (maximum 650 characters including spaces)

8.4. RESEARCH PROPOSALProvide the research proposal on the following pages. Include background, research plan and references (maximum 4 pages including references)

NOTE: The following must be used when preparing your research proposal:

Arial font with a minimum size of 11 point (including tables, table legends and figure legends)

Line spacing of 1.5 lines

Page margins of 2 cm on all sides

DO NOT alter headers or footers



Delete this text and insert the research proposal here

Note: You can format the Research Proposal by selecting Headings, etc., in the Styles (accessible

on MSWord Toolbar).



8.5. BUDGET

Item Description AmountPersonnel/Salaries

$

Maintenance(consumable items to be purchased)

$

Equipment $

Other(computers will not be funded)

$

Total $

Budget Justification (maximum 1,000 characters including spaces)

9. OTHER SUBMITTED GRANT APPLICATIONS

Provide details of grant applications related to this study submitted to other funding bodies in the current year

Funding Body Project Title Budget $

$

$

$

$

$



10. REVIEWERS

As outlined in the Funding Guidelines (section 3: Eligibility), three eligible reviewers must be nominated. For nominations to be eligible, the Applicant must be able to answer Yes to questions.

YES NO

1 Are all nominated reviewers external to MSH, the RDH and all service facilities/organisations with which the investigative team are associated?

2 Is at least one nominated reviewer from interstate or overseas?

3 Are all three nominated reviewers an acknowledged expert in the field (i.e. publication track record, PhD or equivalent research experience)?

4 Are all three nominated reviewers completely independent of the investigative team and without conflict of interest? (See section 4.1 of the 2016 Funding Guidelines)

5 Have all three nominated reviewers agreed to be available from mid-August to mid-October to assess your application?

10.1. REVIEWER 1

Name Click to choose First Name Surname

Health Profession Click to choose

Organisation/Institution Organisation/Institution name

Department Department name

Phone number: Email

:

Availability confirmed? Yes No

Comments (100 characters)

Who contacted this reviewer?

10.2. REVIEWER 2





Phone number: Email

:






10.3. REVIEWER 3





Phone number: Email

:




11. EXCLUDED REVIEWERS

If relevant, list details of up to two reviewers you would like excluded from assessing your application and provide justification for their exclusion

11.1. EXLUDED REVIEWER 1



Organisation/Institution

Organisation/Institution name


Justification Provide details

11.2. EXLUDED REVIEWER 2



Organisation/Institution

Organisation/Institution name


Justification Provide details

12. HUMAN EXPERIMENTATION

Refer to the National Health and Medical Research Council’s National Statement on Ethical Conduct in Human Research (2007 updated March 2014)

Human Ethics YES NODoes the project involve research on human subjects?

Has ethical clearance been granted by a Human Research Ethics Committee?

If YES:1. Provide the HREC reference number:

2. Submit the clearance letter with your application

If NO, has a human ethics application been submitted?


http://www.nhmrc.gov.au/publications/synopses/e72syn.htm



NOTE: Funding of a successful application is conditional upon ethical approval of the proposed research. Notification of ethical approval obtained after submission of this application must be sent to [email protected].

13. AGREEMENTS AND CERTIFICATION OF SUPPORT

13.1. CERTIFICATION BY THE PRINCIPAL INVESTIGATORI, [First Name, Surname], certify that written agreement (such as an email) has been obtained from all investigators named in this application and that all provided details are correct.

I understand that should this application be successful, all named Investigators on this application will be required to sign the Acceptance of Offer.

On behalf of the investigative team, I accept and agree to comply with the ethical standards as set out by the National Health and Medical Research Committee, and any additional standards required by the Human Research Ethics Committee. I certify that research will not commence until all ethics approvals, if required, have been obtained.

Signature of Applicant: _____________________________________________ Date:__________________

13.2.





13.3. CERTIFICATION BY Head(s) of Division/Department

I, [First Name, Surname], certify that:

The proposed research is appropriate to the general facilities in my Division/Department and that I am prepared to have the project carried out in my Division/Department

Experiments involving human subjects/animals conform to the general principles set out in the National Health and Medical Research Committee’s National Statement on Ethical Conduct in Human Research.

Name:_________________________________________________________________________________

Position: _______________________________________________________________________________

Signature:________________________________________________________ Date: __________________

Name of MSH site/university school:__________________________________________________________

Name of Head of Department/Division:________________________________________________________

Name:_________________________________________________________________________________

Position: _______________________________________________________________________________

Signature:________________________________________________________ Date: __________________



Name:_________________________________________________________________________________

Position: _______________________________________________________________________________

Signature:________________________________________________________ Date: __________________





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