JHMRF Application Form: Major project grant · Web viewJune Hancock Mesothelioma Research Fund...

MAJOR PROJECT GRANT

Application Form

JHMRF Reference No:

A maximum award of £250,000 is offered for mesothelioma related research.Grants are available to post-doctoral researchers based in the United Kingdom. Partner organisations in other

EU countries can participate as co-applicants provided the work is led and coordinated by the UK centre

Enter your text for each section in the adjacent box. Submit your completed application form by email to [email protected] in pdf format or as an MS Word file. You may submit one additional file in support of your application if required; please ensure it is labelled and clearly signposted in your application. Applications cannot be accepted by post. Scanned signatures are acceptable.Closing date for applications is 17:00hrs on Friday 30 August 2013. Please ensure you have read and understood the terms and conditions of the award before submitting your application.

Section A: Applicant information Correspondence will be addressed to the principal applicant unless specific instructions are given to the contrary. It is expected that the principal applicant’s salary will be guaranteed during the term of the grant, if it is not a person with such tenure should be a co-applicant.

A.1 Principal ApplicantSurname Title

Forenames

Position

Qualifications

Department address

E-mail address

Dept telephone no.

A.2 Co-applicant (Please request a supplementary form for additional co-applicants)

Surname Title

Forenames

Position

Qualifications

Department address

E-mail address

Dept telephone no.

June Hancock Mesothelioma Research FundRegistered Charity No. 1121784 of 9 Application Form/Project Grant/2013

mailto:[email protected]

A.3 Title of project:

A.4 Department name and address of administering institution where different from principal applicant’s address:

A.5 Period for which support is sought:(state in months)

A.6 Proposed start date:

Section B: Related applications

B.1 Is this or a related application currently being submitted elsewhere? YES NO

If yes, to which organisation?

By what date is a decision expected?

B.2 Has this, or a similar, application been submitted elsewhere over the past year? YES NO

If yes, to which organisation?

What was the outcome?

B.3 Do you currently hold grants from other funding bodies? YES NOIf yes, please provide details of title, value and term of grant(s):

Section C: Details of proposed research

C.1 Category of research

Clinical Laboratory Epidemiology Other

C.2 Details of research project (Maximum 2000 words)Please include: (a) research question(s) to be addressed, (b) aims of the project, (c) work which has led up to the project, (d) how your research will address a previously unanswered question or add to existing knowledge, (e) plan of research, (f) methodology to be used, (g) relevance of the project (if any) to policy and practice, (h) brief timetable and milestones and (i) sources to be consulted.If animals will be used in your research you should justify why, and provide evidence that animal experiments will be the minimum required for statistically valid results. State the species of animals to be used, why this species is most appropriate and the numbers involved.

C.3 Bibliographical references (Maximum 10 references)Please give citations in full, including title of paper and all authors, in alphabetical order.

C.4 Data management & data sharing (Maximum 1000 words)Where appropriate, please include (a) your plans for data management, curation and storage; (b) your policy for sharing data with others, including the management and prioritisation of access to data; (c) your strategy for current and future communication with user communities; and (d) any ethical considerations.


C.5 Lay summary of project (Maximum 1000 words)Please provide a concise summary of your project in language and style that will be understandable to people without special knowledge.The summary should explain why your study focuses on this area of research, how you intend to conduct it, and the anticipated benefits of the research.

C.6 Impact statement (Maximum 300 words)Please summarise the potential impact of the proposed research on the lives of people living with mesothelioma in simple practical terms.

C.7 Research involving human participants, biological samples and personal data relating to living or dead persons, and animals

i Does your project involve human participants? YES NOii Will personal data be used? YES NOiii Will your project involve use of biological samples? YES NO

Has the project been granted ethical approval or other regulatory approvals? YES NOIf no, please state when the ethics of the project will be reviewed, and by whom. Specify any other regulatory approvals that will be sought.

iv Will your project involve the use of animals? YES NOIf the answer is yes, please provide the following details of appropriate approvals:Have the proposed experiments received the approval of your Ethical (or Animal Care and Use) Committee YES NO

Project Licence:Name and address of licensee, Home Office reference and date of issue.

Personal Licence:Names of all researchers licensed under the project, Home Office reference and date of issue.

Certificate of Designation issued to the Host Institution:Name of holder and address, Home Office reference and date of issue.

In the course of your project:v Do you propose to use facilities within the National Health Service (NHS)? YES NOvi Does your research involve patients being cared for by the NHS? YES NO

If the answer is yes, please indicate your plan for obtaining ethical approvals and the organisation that has agreed to be the sponsor for the project under the Research Governance Framework for Health and Social Care, published by the Department of Health in England or the corresponding departments in Northern Ireland, Scotland, Wales or other EU partner countries.

If your project involves a clinical trial:vii Please state whether it is covered by The Medicines for Human Use (Clinical Trials)

Regulations.YES NO

viii Please indicate which organisation has agreed to be the sponsor for the project.

C.8 Risks of research misuse

It is the responsibility of institutions in receipt of JHMRF funding to ensure that any risks that research could be misused for harmful purposes are managed in an appropriate manner.Could your proposed research generate outcomes that could be misused for harmful purposes?If you have answered ‘Yes’, please briefly describe these risks and the steps that you and your institution will take to manage them (no more than 250 words).

YES NO

Section D: Details of financial support requested


D.1 Summary of costs in GB PoundsRemuneration should include superannuation, National Insurance and an allowance for expected salary increments. Full justification for consumables and equipment must be included in the application (see section D.3). The budget cannot be amended once the award is made.

Year 1 Year 2 Year 3 TOTALPersonnel Equipment Consumables Other TOTAL

Will the study described in this application be wholly funded by this grant? YES NOIf no, please state what additional funds are required to complete the work and how they will be secured.

D.2 Breakdown of salary costsSalaries must include annual increments and should be calculated from the proposed starting date of the Grant. Provision should be made to cover future pay increases at the expected inflation rate but merit awards, maternity leave, sick leave, compassionate leave etc are not covered (see terms and conditions). Applicants in a tenured position cannot include provision to cover any contribution to their own salary. Abbreviations: (1) Percentage of full-time equivalent (FTE) hours that will be spent on this research project; (2) BS=Basic Salary; NI=National Insurance; S=Superannuation; LA=London Allowance (if applicable); P=Provision for future pay awards (all pro-rata according to time %).Please request a supplementary form if you require additional fields.Name/post Time

%(1)FTEGrade Spine

PointSalary (2) Year 1 Year 2 Year 3 TOTAL

BS NI S LA P TOTAL

Name/post Time%(1)FTE

Grade SpinePoint

Salary (2) Year 1 Year 2 Year 3 TOTAL

BS NI S LA P TOTAL

Name/post Time%(1)FTE

Grade SpinePoint

Salary (2) Year 1 Year 2 Year 3 TOTAL

BS NI S LA P TOTAL

Total salary costs Year 1 Year 2 Year 3 TOTAL

D.3 Breakdown of expenses


These are for use solely in the research and not for service use. The amount requested should be fully justified and include delivery and miscellaneous costs. For laboratory studies it is expected that ordinary equipment, facilities and materials will be available. Research institution overheads and administrative charges cannot be included.

Year 1 Year 2 Year 3 TOTAL

Equipment (excluding VAT)

Consumables

Other expenses Please specify:

Total expenses

FUNDING: Year 1 Year 2 Year 3 TOTALTotal salary costs requested

Total expenses requested

Total funding requested

Section E: Additional information

E.1 Contact details of the Host Institution’s press or publicity officer

Name & Title Departmentaddress

Telephone no E-mail

E.2 CollaborationName any authority, organisation or individual not named as an applicant, whose permission or collaboration is needed to enable the study to be undertaken. Where applicable, a scanned copy of the correspondence confirming this permission or collaboration should be attached.


Telephone no E-mail

E.3 Supporting InformationPlease provide any additional information to be taken into account in consideration of your application. If this is submitted as an additional file please give a brief description of content and the file name here, and reference in other text where appropriate.

E.4 RefereesPlease suggest two referees (not at your own institution) who might be approached in the evaluation of your application



Telephone no E-mail

Expertise


Telephone no E-mail

Expertise

E.5 Patents/Commercial ActivitiesIs the proposed research likely to lead directly to patentable or otherwisecommercially exploitable results? YES NO

If you have answered ‘Yes’, please give a brief outline of the details. Include details of the authority within the Host Institution who will deal with patents.

E.6 Where did you hear about the JHMRF project grants?

a. The JHMRF website

b. The Mesothelioma UK website

c. RD Info website or email alerts

d. BTOG website or newsletter

e. Other: Please specify below:


Section F: Curriculum vitae of principal applicant

Surname: Forenames:

Date of birth:

Title of current post:

Date of appointment: Expected date of termination:

With whom do you hold your contract of employment?

Source of personal salary support (please indicate all sources of salary):HEFC NHS OTHER Please specify

Previous posts held: (list the most recent first)Dates Position University/Institution

Education/training:Date (mm/yyyy) Degree Subject University/Institution

PublicationsPlease list all relevant publications from the previous three years and up to ten key prior publications.Please list only your original research publications and other scholarly contributions that you consider to be significant. Publications should be in chronological order with the most recent first. Please use a citation format that would enable your publications to be traced by a reviewer.


Section F: Curriculum vitae of co-applicant (please request supplementary forms for co-applicants if required)

Surname: Forenames:

Date of birth:

Title of current post:

Date of appointment: Expected date of termination:

With whom do you hold your contract of employment?

Source of personal salary support (please indicate all sources of salary):HEFC NHS OTHER Please specify

Previous posts held: (list the most recent first)Dates Position University/Institution

Education/training:Date (mm/yyyy) Degree Subject University/Institution

PublicationsPlease list all relevant publications from the previous three years and up to ten key prior publications.Please list only your original research publications and other scholarly contributions that you consider to be significant. Publications should be in chronological order with the most recent first. Please use a citation format that would enable your publications to be traced by a reviewer.


Section G: Authorisations

G.1 Data protectionInformation that you supply to the JHMRF in connection with this application will be used to process your application and for the purposes of audit and/or evaluation. It may be disclosed to external peer reviewers, some of whom may be based outside the UK. It will not be disclosed for any other purpose.

Your personal data will be stored by JHMRF in accordance with the Data Protection Act 1998 and may be used to contact you in the future with details of Fund activities and opportunities that may be of interest to you. It will not be passed on to other organisations without your consent.

JHMRF may publish basic details of successful awards (e.g. on its website or in its Annual Report) and/or anonymise your personal data for research and statistical purposes. JHMRF may also release details of successful awards (including your name and employing Institution, the project title, and the scientific abstracts and lay summary of the research) into the public domain (e.g. via the press, media, internet or via publicly accessible databases).

G.2 Undertakings

I confirm that I have read the data protection statement above.

I confirm that to the best of my knowledge, the information provided in this application is accurate and complete.

I confirm that I have read the terms and conditions under which grants are awarded and, if a grant is made, I agree to abide by them.

I confirm that the necessary facilities will be made available to conduct this research, and will continue to be available for the duration of the award.

Signature of Applicant Date:

Signature of Head of Department Date:

Name and title

Signature of Co-applicant(if appropriate)

Date:

Signature of Co-applicant(if appropriate) Date

:

For and on behalf of the Institution:

Signature of Secretary of Institution/Finance Officer: Date:

Name and post held

Position

Institution

Address

Email

Telephone


JHMRF Application Form: Major project grant · Web viewJune Hancock Mesothelioma Research Fund...

Documents

Transcript of JHMRF Application Form: Major project grant · Web viewJune Hancock Mesothelioma Research Fund...