Research Action Awards 2020: Application Form

1. Applicant details

Title:

Please select:

First Name:

Surname:

Organisation:

Please select:

Position:

Note: to be eligible, you must be employed by one of the Sax Institute's Ordinary Member organisations. If your organisation is not listed, please contact us.

Mobile: Level of experience: Please select

Year your PhD was conferred:

If you are more than 15 years post doctorate, please provide a justification for why your application should be considered. If you do not hold a PhD, please provide justification to demonstrate equivalent level of experience.

(2000 characters maximum)

2. Details of your research and its impact on policy, programs or service delivery Note: The research must have had an impact on policy, programs or service delivery in the past five years

a) Describe your research project or program of research. Include brief comments on purpose, background, aims, method, findings and implications.

(3000 characters maximum)

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b) List up to three (Vancouver citation style preferred) of the most significant peer-reviewed papers and up to three other non-academic publications (e.g. policy papers, reports) that have been published about this research (meaning up to six publications in all). For each of the six articles or publications, include a copy of the publication (all merged into the same PDF as the application form). For large documents, attach the front page of each and relevant chapters/pages.

Do not type text past this point.

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c) Please describe the impact on policy, programs or service delivery that your research has achieved.

(3000 characters maximum)

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d) Please describe the contribution of your research to the change or effect observed on policy, programs or service delivery. To what extent did your research contribute to the policy or practice change (that is, would the change have happened without your research)?

(3000 characters maximum)

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e) Please describe the significance of the impact on health policy, programs or service delivery that resulted from your research. (That is, to what extent did the research have positive effects: for example, on quality of life, cost efficiencies, access to health care, effectiveness of service delivery or appropriateness of services? Discuss these or any other relevant impacts.)

(3000 characters maximum)

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f) Please describe the activities you undertook to translate your research findings (that is, whatefforts did you make to secure policy and/or practice change? What did you do in addition toconducting and publishing the research to ensure your research had an impact?).

(3000 characters maximum)

g) Was the research commissioned by theagency/agencies that used it, or were the enduser(s) involved in the research design?

Please select

If you answered ‘yes’ or ‘partially’ above, please state the name of the agency/agencies:

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Did more than 50% of the impact of your research occur overseas?

NOTE: If you answered ‘yes’ above, you will need to arrange for a second verification report to be prepared and submitted by a research verifier from your affiliated Member Organisation (complete sections 3a and 3b below). The second verifier nominated in section 3b cannot be the same individual as the first verifier named in 3a.

3. Verification

Please provide verification of the impact of your research on policy, programs or service delivery. Please ensure both forms of verification are included in the application. (The two forms of verification are verification by a user of your research, and verification by documentary evidence.)

3a. Complete this section for verification by research user (primary verifier). Ensure you have asked for permission before including the person’s personal information.

Enter the details of the person who has agreed to verify your research and its impact on policy, programs, or service delivery:

Title Please select

First Name:

Surname:

Position: Organisation:

Telephone: Email:

ONLY FOR APPLICANTS WITH >50% IMPACT OVERSEAS: 3b. Complete this section for verification by secondary verifier. This person must be a senior academic from your affiliated Member Organisation and cannot be the same verifier nominated in section 3a.

Enter the details of the person who has agreed to verify your research and its impact:

Title Please select

First Name:

Surname:

Position: Organisation:

Telephone: Email:

PLEASE NOTE

Verification Forms: You (the applicant) must send your nominated research user (and second verifier, if applicable) a copy of this application, and the nominated verifier(s) must each submit their separate Verification Form (available on the Sax Institute website) DIRECTLY to the Sax Institute by 5pm, Monday 24 August 2020.

NB The Sax Institute will not follow up with the research user or secondary verifier. Verification Forms will not be considered if sent directly to the Institute by the applicant.

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Complete this section for verification by documentary evidence: List reports/policy documents (for example, reports, discussion papers, publications or articles, presentations, and/or policy documents) that you are citing as evidence for the impact of your research. Please indicate page numbers or other guides to aid in location of the relevant text.

Attach copies of all listed documentary evidence after the Application Form as part of your merged single PDF document. For large documents, you can attach the front page(s) and the chapters or pages relevant to your application, rather than the entire document.

Please do not type text past this point.

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4. Signature of applicant

Signature: Date:

(dd/mm/2020)

Application checklist – please ensure all boxes are checked before finalising

I have completed all sections of the Application Form

I have saved the Application Form using the following naming convention: Firstname_Surname_2020_Research Action Award Application (for example, Jo_Smith_2020_Research Action Award Application)

I have included up to three peer reviewed papers and up to three other publications (up to six in total) that have been published about my research at the end of the Application Form, as part of the merged PDF document

I have arranged for the Verification Form by research user (primary verifier) to becompleted and submitted by an independent user of the research

If >50% of the impact of my research was overseas, I have arranged for a secondary Verification Form to be completed and submitted by a senior figure from within my affiliated Member Organisation

I will provide a copy of this finalised and signed Application Form to my nominatedVerification Report author(s), to assist them in writing their report(s)

CONTINUED OVERLEAF

Note: there are three options to provide a signature:

1. Print the document, sign with a pen and scan the entire document2. Drop in digital image of your signature3. Type your name in the space provided above.

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I have attached at the end of the Application Form copies of all documentary evidence listed

I have signed the Application Form in Section 4

I have merged this Application Form and all other application materials into a single PDF document and the file is no larger than 10MB.

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Privacy statement

Your personal information is being collected by the Sax Institute in order to assess your application for this Award. If you are not successful in your application, we will retain your application on file indefinitely. We will handle your information in accordance with the Privacy Act 1988 (Cth) and our Privacy Policy and are committed to respecting and protecting your privacy.

If you have received communication from us and you no longer wish to receive those sorts of communications, please email communications@saxinstitute.org.au or call (02) 9188 9500. If you have a query on how your personal information is collected or used or wish to update your details, contact us by email, phone or write to: The Privacy Officer, Sax Institute PO Box K617 Haymarket NSW 1240.