Research Proposal Application.ver1 Kanohi Kitea Full … · Web viewDownload the budget sheet ......

HRC REF: NI:

Full Project Nga Kanohi Kitea Application (FPNKK216)

COVERSHEET

HRC Ref ID#: Click here to enter text.

Applicant: Click here to enter text.

Computer used to complete this form: Click here to enter PC or MAC

Use the Guidelines for details on how to use this form.

This COVERSHEET is for identification purposes. It will be replaced by the online pages (Module 1, Section 1A) in the final submitted application compiled by the HRC Gateway (https://gateway.hrc.govt.nz).

Information can only be entered into the fields indicated. Enter the details above before going to page 2.

When completed, save this form as a pdf file before uploading to Gateway. In the pdf version of this document, Section 1B must begin on page 2.

HRC-FPNKK216 © 2016 Health Research Council of New Zealand. All rights reserved.

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Form HRC - FPNKK

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MODULE 1: APPLICATION INFORMATION

Section 1B:

Tribal Affiliation

Iwi Hapū

Advisors/Independent Expert and Subcontractors (include cultural, research and other)

Title First Names Surname Role Ethnic Identity

1

2

3

4

Note a biographical sketch will need to be provided for each person named here

HRC-FPNKK216 © 2016 Health Research Council of New Zealand. All rights reserved.

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MODULE 2: PROPOSED RESEARCH

Section 2A – Description of Proposed Research

There is a 10 page limit for this section. Use the headings as appropriate. Refer to guidelines for guidance.

Introduction to the health or disability issue being addressed (half a page)

Delete these words and start typing here

Rationale for undertaking the research (half a page)


Proposed methodology/approach to the research1 include the research design and methods

Please note your Independent Expert may need to help you with this.


Potential gains from this research in relation to the issue/topic to be addressed


Involvement of community /partnerships


Proposed team and host institution


Dissemination strategy and potential for translatable results


1

HRC-FPNKK216 © 2016 Health Research Council of New Zealand. All rights reserved. Page 1

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Budget

Download the budget sheet and fill in clearly outlining what your budget is and how it will be spent.



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MODULE 3: REFERENCESThere is no limit to the number of reference pages. Asterisks are to be placed beside applicants’ publications.

Insert references here


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MODULE 4: RELEVANCE OF RESEARCH TO SPECIFIC POPULATION GROUPS

Section 4A

1. Does your research involve* any of the HRC's priority population groups?**

Māori

Pacific peoples

Children and youth

Older adults

People with disability

If no, do not complete this Module

* Leading the research or would provide a separate dataset.

** You may complete these sections if your research does not directly involve priority populations, but you can provide information that would assist the reader to understand or appreciate the scope of your application.

2. Identify the Māori groups consulted regarding this application. Explain why and how they were selected indicate their recommendations, and whether they will have a role in the continued development and/or implementation of this research project. Append any documentation resulting from that consultation.


Section 4B

There is a 2 page limit for this section. Copy and paste subsection if it is applicable to other groups e.g. Pacific

3. Describe how this research project will build capability of the researchers towards building a highly skilled Māori Health Research Workforce.



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4. Describe the process used with the above groups in the development of this application, their recommendations, and if they will have a role in the further development and/or implementation of this research project, or indicate if not applicable. Append any documentation resulting from that consultation.


5. Will the research generate data specific to one or more of these population groups? If so, please give details below. Describe any methodology of specific relevance to the study population.



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MODULE 5: CONTRACT INFORMATION AND BUDGET

Use the HRC Excel Spread sheets ‘NKKbudget.xls’ for Sections 5A – 5D.

For the hardcopy of the application:

Attach a printout of the spreadsheet Sections 5A-5D (Contract Information (Objectives and Milestones), Budget, MOU Budget(s) and FTE Summary) after this page of the application form.

Ensure any page breaks are logically placed to facilitate review.

For the electronic copy of the application:

Upload the electronic file, when submitting the application Word file to the HRC Electronic Application System (EASY). Note required file name convention.


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Section 5E – Justification of Expenses

Justification of research staff (as listed in budget)

Justify the role of all staff (named and un-named). These may be research assistants, technicians, medical staff, interviewers, support staff or similar, whose names or position titles are listed in the budget under “Research Staff” and who have specific FTE involvements. Un-named post-doctoral fellows should also be justified here.

Delete words and start typing here

Justification of Working Expenses and Casual Staff (as listed in budget)


Section 5F – Previous/Current contracts

List previous/current contracts (up to five). Final HRC reports may be made available to Assessing Committees.

Funding Agency

Title of Research

Investigators

Start date and duration

Total Value

Nature of support (1 sentence)

If HRC contract, was Final Report filed? If not, why?

Funding Agency

Title of Research

Investigators


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Total Value



Funding Agency

Title of Research

Investigators


Total Value



Funding Agency

Title of Research

Investigators


Total Value



Funding Agency

Title of Research

Investigators


Total Value


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Section 5G – Other Support

List other research applications awaiting decision (including those to the HRC). Applicants must advise the HRC of the outcome of other research applications. Copy and paste as required for additional pending applications.

Other Research Applications Awaiting Decision:

Funding Agency

Title

Named Investigators

Start Date and Duration

Total Value

Date of Outcome

Areas of Overlap with this Application

Funding Agency

Title

Named Investigators

Start Date and Duration

Total Value

Date of Outcome

Areas of Overlap with this Application


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Co-Funding: What other agencies or end-users have been approached or committed to joint or partial funding of this research?



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Section 5H – Supporting Documents Index

Please list below all memoranda of understanding (MoU) or sub-contracts and letters of collaboration. Copies of all documents should be paper-clipped separately with the original application only.

Referees and Assessing Committee members will see the list below and documents will only be made available on request.

Please note that Appendices can only be included with the permission of the HRC.

Memoranda of Understanding/Subcontracts

List below all memoranda of understanding (MoU) or sub-contracts.

Once this table has been completed, please annotate each document with the appropriate reference number from

the table below (e.g. S01) and the appropriate HRC Ref ID (e.g. 10/123). Press enter on the outside of the last row to create an additional row.

MoU/subcontracts

Ref. Organisation Person (if applicable) $ value (if applicable)

S 01.

Letters of Collaboration

List below letters of collaboration for this research which outline material or actual support.

Once this table has been completed, please annotate each document with the appropriate reference number (e.g.

L01) and the appropriate HRC Ref ID (e.g. 10/123). Press enter on the outside of the last row to create an additional row.

Letters of collaboration

Ref. Organisation Person (if applicable) $ value (if applicable)


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L 01.


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MODULE 6: BIOGRAPHICAL SKETCHES

Must be completed by all those names at the front of this application

Full Name

Department

Organisation

PO Box/Street number

Suburb

City and Postal Code

Telephone

Email

Iwi & hapū (if relevant)

Gender

Present Position & Current employer (if relevant)

If a Named Investigator intends to be absent for a period of longer than one month during the contract duration, please state the reason:

Period of absence Reason

Degrees/Diplomas or Awards

University or organisation

Field Year awarded


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Honours, prizes, scholarships, etc Year awarded

Relevant academic, community and or research experience From year To year

Signature

I certify that the information provided is accurate and current.

Sign: Date:


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Skills and experience relevant to this research (1 page only)

Delete these words and start typing here.

Other forms of research dissemination (1 page only)


Number of Publications (exclude abstracts, proceedings or letters published or presented)

List of Publications from previous five years

- List in reverse date order, starting from current year first,

- And highlight the ones most relevant to this application, by bolding the Author(s) name

- You may include citations, impact factors, and/or journal rankings.



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MODULE 7: ADMINISTRATION

Section 7A – Ethical and Regulatory Agreement

Yes No

Requires human ethical approval?

If this application does not require ethical approval, please briefly provide reason;


If this application requires consent from other regulatory bodies such as ERMA, MAF, DOC, GTAC, SCOTT or Biosafety, please provide reason;


The following information will be used for administrative purposes.

Yes No

Is the proposed research a clinical trial, a community intervention study or innovative treatment?

If yes to the above, do you intend to have an independent Data Monitoring Committee?

If yes to the above, will this be through the HRC’s Data Monitoring Core Committee (DMCC)?

Note: Information on the structure and operating guidelines of the HRC’s DMCC are available from the HRC website. For further information please contact the Secretary to the DMCC, [email protected].

The applicant has read the ‘Guidelines on Ethics in Health Research’, available from the HRC website (http://www.hrc.govt.nz/assets/pdfs/ethgdlns.pdf) and agrees to abide by the principles outlined in it. The undersigned also agrees to provide written evidence before any research procedures commence, that in any study involving animal or human subjects, animal or human materials or personal information, a properly constituted accredited Ethics committee (a list of currently accredited Ethics Committees is available on the HRC website) has examined and agreed to the ethics HRC-FPNKK216 © 2016 Health Research Council of New Zealand. All rights reserved. Page 13

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http://www.hrc.govt.nz/assets/pdfs/ethgdlns.pdf

mailto:[email protected]

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of the proposal outlined in this proposal. If minor changes in the research design or procedures have been required for ethical reasons, the HRC must be informed of them. The undersigned also undertakes to ensure that all regulatory consents are gained before research commences. For further information regarding the ethical approval process, please contact the Secretary to the HRC Ethics Committee, [email protected], or the appropriate accredited Ethics Committee.


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Section 7B – Administrative Agreement

This Module will only be required from successful applicants offered a contract. It is provided here for reference only. No signatures are required. The full administration agreement can be downloaded from the HRC website.

All HRC applications must include an undertaking to abide by the following administrative agreement:

1. It is understood and agreed that this application and any contract awarded as a result of this application is subject to the Health Research Council of New Zealand Rules (“Permissible Use of Research Funding and Operation of Contracts”). Funds will not be expended for any other purpose than described in this application.

2. The host institution agrees and undertakes to bear all risk and claims connected with any operation covered by this application and to indemnify and hold harmless the Council against any and all liability suits, actions, demands, costs or fees on account of death, injuries to persons or property, or any other losses resulting from or connected with any act or omission performed in the course of the research.

3. The host institution agrees and undertakes to support for the duration of any contract, the work described in this application by making available accommodation, basic facilities for research and the services necessary for its fulfilment.

4. The Head of Department agrees to accept this research within his/her department if a contract is made, agrees to provide workload relief for research staff working on this contract (Principles of Full Cost Funding), and is aware that s/he may be requested by the HRC to provide a confidential assessment of the research during the term of the contract.

5. The host institution official designated below agrees to ensure that the research will have been approved, where necessary, by the appropriate institutional biosafety committee and/or all other required regulatory agencies before research is commenced.

6. The applicant(s) agrees to allow specified personal information to be used for statutory and publicity purposes.

7. The host institution has in place policies and processes to ensure that consultation with Māori has occurred and the application is responsive to the needs and diversity of Māori.

We the undersigned have read the above administrative agreement and undertake to abide by the conditions of this agreement in respect of any contract made by the Health Research Council of New Zealand as a result of this application. We the undersigned confirm that the information provided in this application is to the best of our knowledge true, that all sections are correct at the time of application submission, that each NI agrees to the stated FTE% contribution and that funding to any NI from any source will not exceed 100 FTE%.


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Research Proposal Application.ver1 Kanohi Kitea Full … · Web viewDownload the budget sheet ......

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