application form for resarch call - ireland's health · web viewrelevant training...

HSE Research Awards on Ageing

Application Form, May 2017

ESSENTIAL INFORMATION FOR APPLICANTS

Please read the Guidance Notes for the 2017 HSE Research Awards on Ageing in FULL before completing this Application. The purpose, objectives, scope and assessment criteria / process for the

Research Awards on Ageing call are outlined in the Guidance Notes

SUBMISSION REQUIREMENTS: Use Arial font, size 11, single line spacing. Ensure word / page count are consistent

with requirements specified Use language that is succinct and comprehensible to a non-expert or lay person Please make sure that any abbreviations used are fully explained Electronic signatures ARE permitted Ensure ALL relevant documentation / signatures are provided as outlined in the

submission checklist overleaf Applications should be submitted by email to: [email protected] no later than Wednesday

6 September 2017 at 12 noon Applicants should note that there may be a time delay in acknowledging receipt of email

applications We recommend that applicants allow a MINIMUM of TWO hours for the application to

be received Applicants will receive an email message to confirm that the application / supporting

documentation has been received

IMPORTANT: A number of appendices are referred to throughout this application – these are

included at the END of the application for your convenience When completing the application, use this document. DO NOT submit the application

as a PDF document Applicants are strongly encouraged to leave plenty of time to complete the application,

the supporting documents and to obtain the required signatures before submission Late or incomplete applications will NOT be considered For any queries about completing this application please email [email protected] by

Friday 25 August 2017. Queries received after this date may not be answered.

HSE Research Awards on Ageing - Application

mailto:[email protected]

mailto:[email protected]

CHECKLIST FOR APPLICANTS

Please ensure you have included all the information required before submitting your application:

Checklist Please tick to confirmYou have fully completed ALL sections of the

Application Form

YES

The Budget / Breakdown of Proposed

Expenses (Appendix 1)

YES

CV Template for the Principal Investigator /

Co-Investigators (Appendix 2)

YES

The Infrastructure Agreement Form

(Appendix 3)

YES

The Project Management GANTT Chart

(Appendix 4)

YES

The Collaborator Agreement Form

(Appendix 5)

YES

CV Template for Newly Recruited Personnel

(Appendix 6)

YES

Host Institution / Organisation letter of support and

stamp of approval

YES

Ethical Approval (IF REQUIRED) YES N/A

OVERVIEW OF THE APPLICATION (Boxes 1- 3)


1. Proposed research title

Project title

2. Proposed project dates

Start date (can start no earlier than January 2018)

End date(max. 24 months duration)

3. Research project budget (Please complete in Euros (€))(Please note a further breakdown of budget / proposed expenses is required in

Appendix 1)

What is the total cost of delivering the project? €

Amount of budget being sought from the 2017 HSE Research Awards on Ageing

€

Do you have matched* funding for this project?Yes No

If ‘Yes’, for what amount? €

If ‘Yes’, what institution / funding body is providing the matched funding?

*NB: A letter of evidence will be required for shortlisted applications with matched funding


RESEARCH TEAM AND ENVIRONMENT (Boxes 4 – 14)

4. Lead Applicant: Principal Investigator

Name (including title)PositionWill the Principal Investigator hold a post that covers the duration of the research award?

*If No, please see Section Research Team and Environment of the Guidance Notes

Yes No*

Organisation/Faculty

Address

Work telephone and mobile telephone (Please provide both) Email address

Please complete the CV template for the Principal Investigator / Co-Investigators, Appendix Two, outlining your:

(i) Career profile (max. two pages)(ii) Publications (max. one page)(iii) Successful acquisition of external grant income (max. one page)

5. Co-Investigator Number 1

Name (including title)PositionOrganisation/FacultyAddress

Email address

Please complete the CV template for the Principal Investigator / Co-Investigators Appendix Two, outlining your:





Email address





Email address





Email address




9. Collaborator Number 1

Name (including title)PositionDisciplineOrganisationAddress

Email address

10. Collaborator Number 2

Name (including title)PositionDisciplineOrganisationAddress

Email address

11. Collaborator Number 3Name (including title)PositionDisciplineOrganisationAddress

Email address


Email address


Email address


14. Infrastructure and Support (max. 300 words)Please describe the infrastructure, facilities and other resources available at the Host Institution/Organisation which will directly support this specific project. Please ensure that the Infrastructure Agreement Form is signed (Appendix 3)

PROJECT APPLICATION (Boxes 15-27)

15. Current knowledge and the research deficit that is being addressed (max. 1200 words excluding references - complete references in Box 35)

Please outline the background to the proposed research, including current evidence and justification of the need for the proposed research. Describe how the proposed research will add new knowledge/understanding and is innovative

16. Project abstract (max. 200 words)

Please provide a short synopsis of the application, to include the background, aim, objectives, methodology, results of feasibility studies if available, and potential policy and practice implications


17. Aim of project (max. 100 words)

Please state the overall aim of the research project

18. Objectives of project (max. 200 words)

Please state the objectives of the research project (consider developing a minimum of three and no more than five objectives)

19. Deliverables (max. 600 words)

Please describe the deliverables arising from each objective of the project

20.Design and methodological approach (max. 2000 words)Please outline the proposed methodological approach for the project


21.Stakeholder, inter/multidisciplinary and cross-sectoral collaborations (max. 300 words)

Please indicate how you will develop productive stakeholder interactions and inter/multidisciplinary research that cuts across sectors. Include the benefits of the collaborations proposed

22.Risks and challenges (max. 300 words)Please outline potential risks, challenges and obstacles in conducting the proposed research and how you intend to address/overcome these

23. Relevance and potential impact (max. 600 words)Please outline the relevance and potential impact of the proposed research on policy, practice and/or service delivery, with reference to the theme of this call

24. Knowledge management (max. 300 words)Please outline the plan for knowledge management including: (1) knowledge translation and (2) knowledge transfer and dissemination


25. Ethical approvalDoes this application require ethical approval?

Yes No

If ‘Yes’, have you applied for ethical approval? Yes No

If ‘No’, please provide the reason why (for instance if ethical approval is not applicable)If ‘Yes’, please specify the organisation/institution where you have submitted your ethical approval applicationHave you been granted ethical approval? Yes No *

If ‘Yes’, please attach relevant documentation Please scan and submit as an attachment of the

application. For example, SmithHealthService Executive6September2017EthicalApproval

* If ‘No’, please give the reason

26. Ethics (max. 300 words)Please outline your approach to addressing any ethical considerations for the application and how you plan to address them

27. Data protection (max. 300 words)Please demonstrate compliance with relevant data protection legislation in conducting the proposed research


PROJECT MANAGEMENT AND GOVERNANCE STRUCTURES (Box 28)

28.Project management and governance structures (max. 600 words)Please outline the project management and governance structures for this application. Work packages and budget justification should be outlined. A GANTT chart (Appendix 4) and a budget breakdown (Appendix 1) must also be provided

ROLES AND RESPONSBILITIES OF TEAM MEMBERS (Boxes 29 - 31)

Please see overleaf


Principal Investigator:

29. Time to be dedicated to this project in total days* by the Principal Investigator with respect to the work packages over the duration of the projectWork Package Number Work Package Tasks Role of Principal

InvestigatorTime to be dedicated to

this project in total days

Total amount of time to be dedicated to this

project as an overall % of your time

12345

Co-Investigators:

30.Time to be dedicated to this project in total days* by the Co-Investigators with respect to the work packages over the duration of the project

Work Package Number

Work Package Tasks

Co-Investigator Name

Role of Co-Investigator

Time to be dedicated to this

project in total days

Total amount of time to be

dedicated to this project as an

overall % of your time

12345


Collaborators

31.Time to be dedicated to this project in total days* by the Collaborator(s) with respect to the work packages over the duration of the project

Work Package

Work Package Tasks Collab-1Role

Collab-2Role

Collab-3Role

Collab-4Role

Collab-5Role

Time to be dedicated to this project in total days

12345

* One day = eight hours

Please expand these boxes to meet the needs of your project


32. Personnel newly recruited through the award (max. 300 words)Where you have identified a candidate(s) to undertake this work, please include a CV for each candidate (See Appendix 6). Please indicate the % of time commitment for each newly hired candidate and define their role in the project. Where you have not identified a candidate for the post, please supply a job description (max. 300 words) in the box below

HOST INSTITUTION/ORGANISATION (Box 33)

33. Host Institution/Organisation authorising participation in the awardName, title and position of authorised signatory

Email addressSignature of authorised signatory

Date

Official Organisation Stamp


DECLARATION AND SIGNATURES OF APPLICANTS (Box 34)

34. Declaration and SignaturesIn submitting this application, including the information provided in the appendices, I confirm that I have read and understood the HSE Research Awards on Ageing guidance notes and confirm that the application complies with all aspects of the guidelines including ethical, data protection, legislation and intellectual property

Name (BLOCK CAPITALS) Signature Date

Principal InvestigatorCo-Investigator 1

Co-Investigator 2

Co-Investigator 3

Co-Investigator 4

Collaborator 1

Collaborator 2

Collaborator 3

Collaborator 4

Collaborator 5

Electronic signatures are permitted


REFERENCES (Box 35)

35. References in Harvard Style for the literature review (max. 30 references)Please list references cited with respect to the proposed research project

INTERNATIONAL PEER REVIEWERS (Box 36)

You are allowed to indicate a maximum of three individuals who you recommend to review your application and reasons for this. They should be based outside of Ireland. The individuals nominated by you may or may not be contactedName / Position / Organisation / Email

Reasons for nomination

Name / Position / Organisation / Email


Name / Position / Organisation / Email



APPENDICES

APPENDIX 1: THE BUDGET/BREAKDOWN OF PROPOSED EXPENSES

APPENDIX 2: CV TEMPLATE FOR THE PRINCIPAL INVESTIGATOR / CO – INVESTIGATORS

APPENDIX 3: INFRASTRUCTURE AGREEMENT FORM

APPENDIX 4: PROJECT MANAGEMENT GANTT CHART

APPENDIX 5: COLLABORATOR AGREEMENT FORM

APPENDIX 6: CV TEMPLATE FOR NEWLY RECRUITED STAFF


APPENDIX 1. THE BUDGET/BREAKDOWN OF PROPOSED EXPENSES ( Please complete this table in Euros)

Description Amount Requested (€)

Staff

Training

Consumables

Travel

Overhead contributions

Other

TOTAL (€)

Staff: Staff costs must be outlined for each salaried member of staff involved in the project and includes the gross annual salary. The salary scale and point on the salary scale to which the candidate will be appointed should be defined. The employer’s PRSI contribution is calculated at 10.75% of the gross salary. The pension contribution will be a maximum of 20% of the gross salary, and should be in line with the host institution’s pension policy for contract staff.

Training: Relevant training courses/workshops for funded research personnel.

Consumables: The upper cost for consumables during the lifetime of the award is €4000. This is inclusive of small items of equipment, typical consumables costs such as stationery, and also includes transcribing and dissemination costs.

Travel: Travel for participants to undertake field work, attend conferences/workshops to disseminate research findings. It is recommended that at least one national and one international event are attended for dissemination purposes.

Overhead contributions: A contribution to overheads of 30% of total direct costs is allowed for each research project, or 25% for desk based research.

Other: Additional categories may be added as ‘other’, providing a clear description of what the funding will be used for, for instance data collection or other similar costs.


APPENDIX 2. CV TEMPLATE FOR THE PRINCIPAL INVESTIGATOR / CO – INVESTIGATORS (max. four pages)

NAME

ORGANISATION

WORK AND MOBILE TELEPHONE NUMBERCAREER PROFILE (max. two pages)Employment history in the area of research within the last five years, relevant to this application. NB: Principal Investigators please demonstrate your ability to lead a researcher and manage relationships with Co-Investigators, Collaborators and the Host Institution

PUBLICATIONS (max. one page)Please provide examples of your “most impactful” publications in peer-reviewed journals in the last five years (max. five examples). Please highlight in bold articles where you are the lead author

SUCCESSFUL ACQUISITION OF EXTERNAL GRANT INCOME (max. one page)Award Type Start & end date of

awardTitle of the award Amount of

award (€)Describe your role –PI, Co-I, Collaborator

Expand table by adding rows as required (Please DO NOT exceed the page limits)


APPENDIX 3. INFRASTRUCTURE AGREEMENT FORM

Please describe the nature of the support provided to the research team from the Host Institution/Organisation? (max. 600 words)

Please provide details on any income and/or expenditure related to the research project arising out of support from the Host Institution/Organisation*. Please note that items of expenditure which are being requested from the award budget must also be included in the budget (Appendix 1) of the Application Form.

Category Cost of Support (€) Type of Income/Expenditure**

Overheads***Other

* Please edit the table as necessary to include all categories.** For example, an in-kind contribution, funding requested from project budget, funding leveraged from elsewhere.*** If an overhead is requested as part of securing the services of the Host Institution/Organisation, it must be included within the overall research awards overhead contribution to the project budget. It is the responsibility of the Principal Investigator and the Host Institution/Organisation to establish any sub-agreements as to how the overhead payments from the research awards will be distributed in such a case.

Please provide details and justification for all items listed in the table above (max. 200 words)


Principal InvestigatorAs the Principal Investigator I confirm, to the best of my knowledge, that the information provided in this application is correctName (BLOCK CAPITALS)Signature

Date

Director or any other person authorised on behalf of the Host Institution/Organisation or equivalent to endorse this agreement. As the Director of the Host Institution/Organisation, or equivalent, I confirm, to the best of my knowledge, that the information provided is correct

Name (BLOCK CAPITALS)Signature

Date

Official Organisation Stamp


APPENDIX 4. PROJECT MANAGEMENT GANTT CHART

Work package and timelines MonthsWork

PackageNumber

Objective(s) Task Deliverable (s)

1 2 3 4 5 6 7 8 9 10 11 12

12345

Please complete this GANTT chart to meet the needs of your project. Expand columns as required to meet the duration of the project


APPENDIX 5. COLLABORATOR AGREEMENT FORM

CollaboratorName, institution/company and address

What are the objectives of the collaboration? (max. 150 words)

For industrial collaborator(s), do any of the academic applicants have a direct or indirect interest (consultancy, shareholding, options etc.)? If so, what is the nature of the interest and how are conflicts of interest between the parties being managed? (max. 150 words)

Are there any restrictions on technology transfer, knowledge transfer and/or dissemination of the results from this project arising out of the collaboration? If so, what are these restrictions? (max. 150 words)


Please provide details on any income and/or expenditure related to the research project arising out of this collaboration*. Please note that items of expenditure which are being requested from the award budget must also be included in the budget (Appendix 1) of the Application Form.

Category Cost of Support (€)

Type of Income/Expenditure** Please provide details and justification for all items listed

ConsumablesExpert Advice * Please edit the table as necessary to include all categories.** For example, an in-kind contribution, funding requested from project budget, funding leveraged from elsewhere.

Up to five Collaborators can be included in the Application.

Please complete a separate Collaborator Agreement Form (Appendix 5) for each Collaborator and paste into this section.

Electronic signatures are permitted.


APPENDIX 6. CV TEMPLATE FOR NEWLY RECRUITED PERSONNEL (max. one page)

NAME

EDUCATIONPlease include details of post-graduate training relevant to area, awarding body and date

CAREER PROFILEEmployment gained within the last five years relevant to the position

ROLE IN PROJECTPlease include details of key responsibilities and percentage of time to be dedicated to the project


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