TRADIM Research Grants - Metro South Health Web viewTRADIM Research Grant ... nurse or allied health...
Transcript of TRADIM Research Grants - Metro South Health Web viewTRADIM Research Grant ... nurse or allied health...
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
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
CI2 Click to choose First name Surname Click to choose Click to choose
CI3 Click to choose First name Surname Click to choose Click to choose
CI4 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
Trauma and Disaster Management Research Grant Scheme Applicant:
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
TRADIM Research Grant Application Page 3
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If there is insufficient space in the below table just include the most relevant grants to this application.
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Trauma and Disaster Management Research Grant Scheme Applicant:
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
Expected 2016 time allocation to:
This study (hr/wk): Other studies (hr/wk):
Does CI1 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)
2.5. CI1 PUBLICATIONSList CI1 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.
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
If there is insufficient space in the below table just include the most relevant grants to this application.
TRADIM Research Grant Application Page 5
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Funding body and typeStart dateEnd date
Funding Amount
Relevant to this application?
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TRADIM Research Grant Application Page 6
Trauma and Disaster Management Research Grant Scheme Applicant:
3. CO-INVESTIGATOR 2
3.1. CI2 CONTACT DETAILS
CI2 Name Click to choose First Name Surname
Position
Organisation and Department
Organisation and Department name
Phone number
Email address
3.2. CI2 ACADEMIC QUALIFICATIONS
Qualification Institution Date DD/MM/YEAR
DD/MM/YEAR
DD/MM/YEAR
DD/MM/YEAR
3.3. CI2 PARTICIPATIONSummarise the role of CI2 in the broad research plan proposed in this application (maximum 300 characters including spaces)
3.4. CI2 RESEARCH TIME
Expected 2016 time allocation to:
This study (hr/wk): Other studies (hr/wk):
Does CI2 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)
3.5. CI2 PUBLICATIONSList CI2 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.
3.6. CI2 GRANTSProvide details of research funding received by CI2 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.
TRADIM Research Grant Application Page 7
Trauma and Disaster Management Research Grant Scheme Applicant:
Funding body and typeStart dateEnd date
Funding Amount
Relevant to this application?
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$ Yes
No
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TRADIM Research Grant Application Page 8
Trauma and Disaster Management Research Grant Scheme Applicant:
4. CO-INVESTIGATOR 3
4.1. CI3 CONTACT DETAILS
CI3 Name Click to choose First Name Surname
Position
Organisation and Department
Organisation and Department name
Phone number
Email address
4.2. CI3 ACADEMIC QUALIFICATIONS
Qualification Institution Date DD/MM/YEAR
DD/MM/YEAR
DD/MM/YEAR
DD/MM/YEAR
4.3. CI3 PARTICIPATIONSummarise the role of CI3 in the broad research plan proposed in this application (maximum 300 characters including spaces)
4.4. CI3 RESEARCH TIME
Expected 2016 time allocation to:
This study (hr/wk): Other studies (hr/wk):
Does CI3 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)
4.5. CI3 PUBLICATIONSList CI3 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.
4.6. CI3 GRANTSProvide details of research funding received by CI3 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.
TRADIM Research Grant Application Page 9
Trauma and Disaster Management Research Grant Scheme Applicant:
Funding body and typeStart dateEnd date
Funding Amount
Relevant to this application?
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TRADIM Research Grant Application Page 10
Trauma and Disaster Management Research Grant Scheme Applicant:
5. CO-INVESTIGATOR 4
5.1. CI4 CONTACT DETAILS
CI4 Name Click to choose First Name Surname
Position
Organisation and Department
Organisation and Department name
Phone number
Email address
5.2. CI4 ACADEMIC QUALIFICATIONS
Qualification Institution Date DD/MM/YEAR
DD/MM/YEAR
DD/MM/YEAR
DD/MM/YEAR
5.3. CI4 PARTICIPATIONSummarise the role of CI4 in the broad research plan proposed in this application (maximum 300 characters including spaces)
5.4. CI4 RESEARCH TIME
Expected 2016 time allocation to:
This study (hr/wk): Other studies (hr/wk):
Does CI4 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)
5.5. CI4 PUBLICATIONSList CI4 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.
5.6. CI4 GRANTSProvide details of research funding received by CI4 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.
TRADIM Research Grant Application Page 11
Trauma and Disaster Management Research Grant Scheme Applicant:
Funding body and typeStart dateEnd date
Funding Amount
Relevant to this application?
[DD/MM/YYYY]
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$ Yes
No
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TRADIM Research Grant Application Page 12
Trauma and Disaster Management Research Grant Scheme Applicant:
6. ASSOCIATE-INVESTIGATOR 1
6.1. AI1 CONTACT DETAILS
AI1 Name Click to choose First Name Surname
Position
Organisation and Department
Organisation and Department name
Phone number
Email address
6.2. AI1 ACADEMIC QUALIFICATIONS
Qualification Institution Date DD/MM/YEAR
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)
TRADIM Research Grant Application Page 13
Trauma and Disaster Management Research Grant Scheme Applicant:
7. ASSOCIATE-INVESTIGATOR 2
7.1. AI2 CONTACT DETAILS
AI2 Name Click to choose First Name Surname
Position
Organisation and Department
Organisation and Department name
Phone number
Email address
7.2. AI2 ACADEMIC QUALIFICATIONS
Qualification Institution Date DD/MM/YEAR
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)
TRADIM Research Grant Application Page 14
Trauma and Disaster Management Research Grant Scheme Applicant:
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
TRADIM Research Grant Application Page 15
Trauma and Disaster Management Research Grant Scheme Applicant:
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).
TRADIM Research Grant Application Page 16
Trauma and Disaster Management Research Grant Scheme Applicant:
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 $
$
$
$
$
$
TRADIM Research Grant Application Page 17
Trauma and Disaster Management Research Grant Scheme Applicant:
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
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?
TRADIM Research Grant Application Page 18
Trauma and Disaster Management Research Grant Scheme Applicant:
10.3. REVIEWER 3
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?
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
Name Click to choose First Name Surname
Health Profession Click to choose
Organisation/Institution
Organisation/Institution name
Department Department name
Justification Provide details
11.2. EXLUDED REVIEWER 2
Name Click to choose First Name Surname
Health Profession Click to choose
Organisation/Institution
Organisation/Institution name
Department Department 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?
TRADIM Research Grant Application Page 19
Trauma and Disaster Management Research Grant Scheme Applicant:
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.
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Trauma and Disaster Management Research Grant Scheme Applicant:
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 of MSH site/university school:__________________________________________________________
Name of Head of Department/Division:________________________________________________________
Name:_________________________________________________________________________________
Position: _______________________________________________________________________________
Signature:________________________________________________________ Date: __________________
Name of MSH site/university school:__________________________________________________________
Name of Head of Department/Division:________________________________________________________
TRADIM Research Grant Application Page 21