yorkshirecancerresearch.org.ukyorkshirecancerresearch.org.uk/wp...form-2017-1.docx · web...
TRANSCRIPT
Deadline: 12 noon Thursday 15 th June 2017
Applications must be sent in Microsoft Word format to [email protected]. PDFs will not be accepted. Please use the filename format “[SURNAME] – 2017 FULL APPLICATION”. Please also submit 15 double-sided hard copies to arrive by the deadline above. If your application is successful in the Strategic Fit Assessment we will require you to provide additional hard copies.
PRIVACY STATEMENT
For full details on how we use your information please visit www.ycr.org.uk/privacy.
BEFORE YOU BEGIN
PLEASE EMAIL [email protected] TO ARRANGE A CALL TO DISCUSS THE SCOPE OF YOUR PROJECT.Check this box to confirm that you have been advised by the Charity that your application is in scope for this funding round. Applications submitted without this consultation will not be eligible.Check this box if you have sought advice from a relevant Clinical Studies Group.
Check this box if have you consulted with NIHR Clinical Research Network Yorkshire and Humber about this proposal.
Check this box to confirm that you have read the checklist at the end of this application.
Check this box to confirm you have read the Information for Applicants, Award Conditions and Policies for Awards.
SECTION 1PRINCIPAL APPLICANT’S DETAILS
Please complete in Calibri font size 10
Principal Applicant
Current Post & %FTE % FTE on this project
Will your CURRENT employment extend beyond the end date of this
project? If no, give the end date.
Principal Applicant phone number
Principal Applicant email address
Host Organisation / Department
Postal address
Town/City Postcode
Signature(All applicants MUST sign)
Electronic signature
PERSONAL ASSISTANT DETAILSPersonal Assistant name
Personal Assistant email
Personal Assistant phone number
Registered Charity: 516898. Yorkshire Cancer Research is a company limited by guarantee registered in England, number 1919823.Registered Office: Jacob Smith House, 7 Grove Park Court, Harrogate HG1 4DP
1
2017 Funding Round“Tackling Yorkshire’s Cancer Problems”
APPLICATION FORM
2Registered Charity: 516898. Yorkshire Cancer Research is a company limited by guarantee registered in England, number 1919823.
Registered Office: Jacob Smith House, 7 Grove Park Court, Harrogate HG1 4DP
LAY REPRESENTATIVE
Lay Representative Email/phone number
Check this box to confirm the lay representative has given permission for their contact details to be provided to us.
Lay representative guidance can be found in the Information for Applicants document
SECTION 1CO-APPLICANTS’ DETAILS
Surname Forename Title click titleCurrent Post & %FTE % FTE on this project
Will your CURRENT employment extend beyond the end date of this project? If
not, give the end date.
Co-applicant email address
Signature(All applicants MUST sign)
Electronic signature
Surname Forename Title click title
Current Post & %FTE % FTE on this project
Will your CURRENT employment extend beyond the end date of this project? If
not, give the end date.
Co-applicant email address
Signature(All applicants MUST sign)
Electronic signature
Surname Forename Title click title
Current Post & %FTE % FTE on this project
Will your CURRENT employment extend beyond the end date of this project? If
not, give the end date.
Co-applicant email address
Signature(All applicants MUST sign)
Electronic signature
Surname Forename Title click title
Current Post & %FTE % FTE on this project
Will your CURRENT employment extend beyond the end date of this project? If
not, give the end date.
Co-applicant email address
Signature(All applicants MUST sign)
Electronic signature
Surname Forename Title click title
Current Post & %FTE % FTE on this project
Will your CURRENT employment extend beyond the end date of this project? If
not, give the end date.
Co-applicant email address
3Registered Charity: 516898. Yorkshire Cancer Research is a company limited by guarantee registered in England, number 1919823.
Registered Office: Jacob Smith House, 7 Grove Park Court, Harrogate HG1 4DP
Signature(All applicants MUST sign)
Electronic signature
SECTION 1CO-APPLICANTS’ DETAILS
Surname Forename Title click titleCurrent Post & %FTE % FTE on this project
Will your CURRENT employment extend beyond the end date of this project? If not, give the end date.
Co-applicant email address
Signature(All applicants MUST sign)
Electronic signature
Surname Forename Title click title
Current Post & %FTE % FTE on this project
Will your CURRENT employment extend beyond the end date of this project? If not, give the end date.
Co-applicant email address
Signature(All applicants MUST sign)
Electronic signature
Surname Forename Title click title
Current Post & %FTE % FTE on this project
Will your CURRENT employment extend beyond the end date of this project? If not, give the end date.
Co-applicant email address
Signature(All applicants MUST sign)
Electronic signature
Surname Forename Title click title
Current Post & %FTE % FTE on this project
Will your CURRENT employment extend beyond the end date of this project? If not, give the end date.
Co-applicant email address
Signature(All applicants MUST sign)
Electronic signature
Surname Forename Title click title
Current Post & %FTE % FTE on this project
Will your CURRENT employment extend beyond the end date of this project? If not, give the end date.
Co-applicant email address
Signature(All applicants MUST sign)
Electronic signature
4Registered Charity: 516898. Yorkshire Cancer Research is a company limited by guarantee registered in England, number 1919823.
Registered Office: Jacob Smith House, 7 Grove Park Court, Harrogate HG1 4DP
5Registered Charity: 516898. Yorkshire Cancer Research is a company limited by guarantee registered in England, number 1919823.
Registered Office: Jacob Smith House, 7 Grove Park Court, Harrogate HG1 4DP
SECTION 2ABOUT YOUR PROJECT
Project title
Proposed start date (dd/mm/yyyy)
Project length (months)
Which funding priority does your project address?
Living with and beyond cancer 1. Preventing recurrence and promoting better quality of survival for people living with
and beyond cancer in Yorkshire 2. Interventions to address inequalities in access to survivorship services 3. Living with and managing advanced cancer
Early diagnosis 4. Interventions which improve the awareness of cancer signs and symptoms, and
translate this awareness into action, targeted towards at risk populations 5. Developing and delivering interventions that can achieve a significant
stage shift in diagnosis 6. Addressing variations in cancer screening uptake at a local level
Clinical trials 7. Expanding clinical trials in Yorkshire for wider-scale patient benefit
Total amount requested
Click on the grey boxes below and choose from the drop down list
Is your current research supported by other funding
bodies?
Click on Yes/No If yes please give organisation details and award value.
Are you currently applying elsewhere for support for work
relating to this project?
Click on Yes/No If yes please give organisation details and expected outcome date.
Is this application or any part of it currently being submitted
elsewhere?
Click on Yes/No If yes please give organisation details and expected outcome date.
Does this application follow on from a previously funded
Yorkshire Cancer Research award?
Click on Yes/No If yes please give award number and details.
Is this a full or partial resubmission of a previous
application to Yorkshire Cancer Research?
Click on Yes/No If yes give date and funding round. Please note that resubmissions are only eligible if specifically invited.
Are you considering applying for NIHR portfolio status for your
study?
Click on Yes/No If yes give details on relevant discussions about portfolio adoption.
Will animals be used in this project?
Click on Yes/No Please note that pre-clinical work is unlikely to be in scope for the 2017 Funding Round. See Information for Applicants for further details.
6Registered Charity: 516898. Yorkshire Cancer Research is a company limited by guarantee registered in England, number 1919823.
Registered Office: Jacob Smith House, 7 Grove Park Court, Harrogate HG1 4DP
SECTION 2ABOUT YOUR PROJECT
Project summary in lay terms – i.e. for press releases or newsletters to the general public (100 words MAX)
Word count
Technical summary (100 words MAX)
Word count
What need does your project address? (150 words MAX)
Word count
7Registered Charity: 516898. Yorkshire Cancer Research is a company limited by guarantee registered in England, number 1919823.
Registered Office: Jacob Smith House, 7 Grove Park Court, Harrogate HG1 4DP
SECTION 2ABOUT YOUR PROJECT
What impact will your research have on cancer patients and/or cancer outcomes in Yorkshire? (150 words MAX)
Word count
If this research is successful what is the timescale until patient/public benefit is realised and what are the key milestones towards achieving this benefit? (150 words MAX)
Word count
Will this project involve members of the public, patient samples or use of patient data? If yes, please give the number of people and/or samples.
8Registered Charity: 516898. Yorkshire Cancer Research is a company limited by guarantee registered in England, number 1919823.
Registered Office: Jacob Smith House, 7 Grove Park Court, Harrogate HG1 4DP
SECTION 2PROJECT MILESTONE DIAGRAM
Please provide a diagram (eg Gantt chart) with a graphical representation of the project milestones.
9Registered Charity: 516898. Yorkshire Cancer Research is a company limited by guarantee registered in England, number 1919823.
Registered Office: Jacob Smith House, 7 Grove Park Court, Harrogate HG1 4DP
SECTION 2PATIENT/PUBLIC BENEFIT DIAGRAM
Please provide a diagram with a graphical representation on delivery of patient/public benefit. Please ensure you indicate whether this is anticipated during and/or beyond the timeframe of the Award itself.
10Registered Charity: 516898. Yorkshire Cancer Research is a company limited by guarantee registered in England, number 1919823.
Registered Office: Jacob Smith House, 7 Grove Park Court, Harrogate HG1 4DP
SECTION 3FULL PROJECT DESCRIPTION
Projects ≤ £350k Projects > £350kCombined project background and detailed plan MAX 2500
words plus up to 5 tables/figuresCombined project background and detailed plan MAX 15
pages including figures/tables
Project backgroundPlease complete these sections in Calibri font size 10 with 1.5 line spacing
SECTION 3FULL PROJECT DESCRIPTION
11Registered Charity: 516898. Yorkshire Cancer Research is a company limited by guarantee registered in England, number 1919823.
Registered Office: Jacob Smith House, 7 Grove Park Court, Harrogate HG1 4DP
Detailed project plan Including: 1) milestones 2) cost justifications and 3) if your work has statistical analyses, relevant power calculations.
Word count (or page count for larger applications)
SECTION 3REFERENCES AND SUPPORTING LITERATURE
Please list each reference in number order.
12Registered Charity: 516898. Yorkshire Cancer Research is a company limited by guarantee registered in England, number 1919823.
Registered Office: Jacob Smith House, 7 Grove Park Court, Harrogate HG1 4DP
Why are you and your team well placed to deliver the objectives of this project? (100 words MAX)
13Registered Charity: 516898. Yorkshire Cancer Research is a company limited by guarantee registered in England, number 1919823.
Registered Office: Jacob Smith House, 7 Grove Park Court, Harrogate HG1 4DP
Word count
SECTION 4RESEARCH OUTPUTS AND INTELLECTUAL PROPERTY
What plans are in place to protect or commercialise any research output(s) including intellectual property? (100 words MAX)
Word count
14Registered Charity: 516898. Yorkshire Cancer Research is a company limited by guarantee registered in England, number 1919823.
Registered Office: Jacob Smith House, 7 Grove Park Court, Harrogate HG1 4DP
SECTION 5PROJECT COSTINGS
PLEASE CONSULT THE INFORMATION FOR APPLICANTS DOCUMENT BEFORE STARTING THIS SECTION
SALARY REQUESTED FOR APPLICANTS AND STAFF
ONLY include salaries of applicants when they are a directly incurred cost of this project (see Information for Applicants)
Staff costings (including NI and superannuation)
Name and job title Grade and %FTE Year 1 (£) Year 2 (£) Year 3 (£) Year 4 (£) Year 5 (£) TOTAL (£)
TOTAL SALARY COSTS
IF COSTINGS ARE NOT TOTALLED ACCURATELY YOUR APPLICATION MAY NOT BE CONSIDERED
NON-SALARY PROJECT COSTS
Please see Information for Applicants for our costing policyIndividual costs of £3000 or over must be itemised and/or a quote provided
Cost details Year 1 (£) Year 2 (£) Year 3 (£) Year 4 (£) Year 5 (£) TOTAL (£)
TOTAL COSTS
IF COSTINGS ARE NOT TOTALLED ACCURATELY YOUR APPLICATION MAY NOT BE CONSIDEREDSUMMARY OF TOTAL COSTS
Total salary costs PLEASE CONFIRM YOU HAVE CHECKED YOUR COSTINGS (E.G.
IN EXCEL)Total non-salary project costsOVERALL TOTAL
(must match total provided in Section 2) Yes/No
IF COSTINGS ARE NOT TOTALLED ACCURATELY YOUR APPLICATION MAY NOT BE CONSIDERED
15Registered Charity: 516898. Yorkshire Cancer Research is a company limited by guarantee registered in England, number 1919823.
Registered Office: Jacob Smith House, 7 Grove Park Court, Harrogate HG1 4DP
SECTION 6APPLICANT EXPERTISEPRINCIPAL APPLICANT
Surname Forename
Relevant qualification Subject Grade Organisation Date
Relevant posts held (include job title) Organisation Date
Please describe your track record in delivering outcomes related to the proposed work (150 words MAX)
Word countPlease provide details of up to 5 of your recent publications (please include titles)
Applicants for projects >£350k may supply all relevant publications
Registered Charity: 516898. Yorkshire Cancer Research is a company limited by guarantee registered in England, number 1919823.Registered Office: Jacob Smith House, 7 Grove Park Court, Harrogate HG1 4DP
16
COPY THIS PAGE FOR ADDITIONAL CO-APPLICANTS AND RENUMBER
CO-APPLICANT 1Surname Forename
Relevant qualification Subject Grade Organisation Date
Relevant posts held (include job title) Organisation Date
Please describe your track record in delivering outcomes related to the proposed work (150 words MAX)
Word countPlease provide details of up to 5 of your recent publications (please include titles)
Co-Applicants for projects >£350k may supply all relevant publications
17Registered Charity: 516898. Yorkshire Cancer Research is a company limited by guarantee registered in England, number 1919823.
Registered Office: Jacob Smith House, 7 Grove Park Court, Harrogate HG1 4DP
COPY THIS PAGE FOR ADDITIONAL STAFF MEMBERS AND RENUMBER
ADDITIONAL STAFF 1Surname Forename
Relevant qualification Subject Grade Organisation Date
Relevant posts held (include job title) Organisation Date
Please describe your track record in delivering outcomes related to the proposed work (150 words MAX)
Word countPlease provide details of up to 5 of your recent publications (please include titles)
Staff members for projects >£350k may supply all relevant publications
18Registered Charity: 516898. Yorkshire Cancer Research is a company limited by guarantee registered in England, number 1919823.
Registered Office: Jacob Smith House, 7 Grove Park Court, Harrogate HG1 4DP
SECTION 7PREVIOUS YORKSHIRE CANCER RESEARCH AWARDS
THIS SECTION IS ONLY FOR CURRENT OR PREVIOUS YORKSHIRE CANCER RESEARCH AWARD HOLDERSPLEASE COPY THIS PAGE FOR ANY ADDITIONAL AWARDS
Please complete if any applicant on this project has been a Principal Applicant on a Yorkshire Cancer Research award with a start date within the past five years.
Project title and award reference
Project start date (DD/MM/YYYY) Project end date (DD/MM/YYYY)
Award holder(s)
Brief summary of project impact including advancement of knowledge, contribution to clinical practice, commercial exploitation and career development
Peer reviewed research papers directly resulting from this award (full academic citation)
Page number where Yorkshire Cancer Research is acknowledged
Please indicate whether research papers have been submitted to [email protected] . Please provide Yorkshire Cancer Research disclosure reference number(s) or any IP opinions from Yorkshire Cancer Research with relevant dates.
Have either of the following been provided? If so, please give relevant dates.
1) Annual Reports
2) KPI reports
19Registered Charity: 516898. Yorkshire Cancer Research is a company limited by guarantee registered in England, number 1919823.
Registered Office: Jacob Smith House, 7 Grove Park Court, Harrogate HG1 4DP
SECTION 8PREFERRED REVIEWERS
Applicants must name AT LEAST 2 and up to 4 preferred reviewers from OUTSIDE YORKSHIRE.Those who have co-published with ANY applicant within the past 3 years are not eligible.
Reviewer 1
Name Email Tel
Organisation
Expertise
Reviewer 2
Name Email Tel
Organisation
Expertise
Reviewer 3
Name Email Tel
Organisation
Expertise
Reviewer 4
Name Email Tel
Organisation
Expertise
SECTION 8EXCLUDED REVIEWERS
Applicants may name up to 2 EXCLUDED reviewers from OUTSIDE YORKSHIRE
Excluded reviewer 1Name Email
Organisation
Excluded reviewer 2Name Email
Organisation
20Registered Charity: 516898. Yorkshire Cancer Research is a company limited by guarantee registered in England, number 1919823.
Registered Office: Jacob Smith House, 7 Grove Park Court, Harrogate HG1 4DP
SECTION 9ACCEPTANCE OF AWARD CONDITIONS AND POLICIES FOR AWARDS
I/We shall be actively engaged in, and in day-to-day control of, the project. I/We have read The Charity’s current Award Conditions and Policies for Awards. If my/our application is
successful I/we agree to abide by them.
Signature of Principal Applicant Electronic signature
Date
This application MUST be submitted via the Principal Applicant’s Line Manager or Head of Department AND the officer responsible for administrating any award granted.
Each should sign the following declaration:
I confirm I have read the application and that, if awarded, the work will be accommodated and administered in the Organisation/Department in accordance with the Award Conditions and Policies for Awards.
The staff gradings and salaries quoted are correct and in accordance with the normal practice of this Organisation.
HEAD OF DEPARTMENT/LINE MANAGERTitle click title Name
Job title
Organisation
Postal Address
Address line 1
Address line 2
Town/City
Postcode
Phone number Email
Signature Electronic signature Date(dd/mm/yyyy)
ADMINISTRATIVE AUTHORITYTitle click title Name
Job title
Organisation
Postal Address
Address line 1
Address line 2
Town/City
Postcode
Phone number Email
Signature Electronic signature Date(dd/mm/yyyy)
SECTION 10COMMUNICATIONS
21Registered Charity: 516898. Yorkshire Cancer Research is a company limited by guarantee registered in England, number 1919823.
Registered Office: Jacob Smith House, 7 Grove Park Court, Harrogate HG1 4DP
By completing the section below we can keep you up to date with our latest news about the work we do, the research we fund and other ways you can get involved, including fundraising. We promise never to share your personal
information with any other organisation outside of Yorkshire Cancer Research for their marketing purposes.
You can unsubscribe at any time by contacting [email protected] or calling 01423 877229.
For full details on how we use your information please visit www.ycr.org.uk/privacy.
Please tick the relevant boxes below to indicate your preferences about being contacted in the future.
PLEASE NOTE: Even if you already receive our research newsletter or other Yorkshire Cancer Research news, you must again confirm here your permission for us to send you this information due to changes in fundraising
regulations and data protection.
Applicant name
If you would like to receive our funding
announcements and research newsletter, please
tick here.
If you would like our latest news about other ways you can get involved including fundraising,
please tick here.
Lay representative name
22Registered Charity: 516898. Yorkshire Cancer Research is a company limited by guarantee registered in England, number 1919823.
Registered Office: Jacob Smith House, 7 Grove Park Court, Harrogate HG1 4DP
23Registered Charity: 516898. Yorkshire Cancer Research is a company limited by guarantee registered in England, number 1919823.
Registered Office: Jacob Smith House, 7 Grove Park Court, Harrogate HG1 4DP
CHECKLIST FOR APPLICANTS – PLEASE COMPLETE BEFORE SUBMITTING YOUR APPLICATION
Have you read the Information for Applicants, Award Conditions and Policies for Awards?
Have you consulted with a member of the Research and Innovation team to determine whether your application is in scope for this Funding Round?
Have you consulted with a relevant Clinical Studies Group?
Have you consulted the NIHR Clinical Research Network Yorkshire and Humber team to discuss NIHR portfolio adoption and potential CRN support for your study?
Have you completed all sections of the application form?
Have all the applicants signed Section 1? Have applicants provided employment end dates if they fall before the end of the project?
Have you had a Patient or Lay Representative read and comment on the application and particularly the project lay summary? Do you have permission to provide their contact details to Yorkshire Cancer Research?
Have you checked that all amounts in Section 5 have been added up correctly? We recommend using Excel to ensure totals are correct. Are only direct project costs included? Have you provided a breakdown for any costs over £3000?
Applications with costings that do not add up correctly may not be considered
Has the form been signed by the Head of Department/Line Manager and the appropriate Organisation Administrative Authority in Section 9?
Have all applicants completed Section 10 on communication preferences?
Have you ensured that you have not altered the format of the original application form? Note that applications must conform to the word count and formatting rules where indicated.
The only additions allowed to the application are notices of ethical approval, letters signifying collaboration and quotations for costings which you can include at the end of the application or send as attachments in PDF format. Manuscripts and papers may be sent to accompany the application as PDF attachments if they have been accepted for publication and they are not available in the public domain. Please also send 15 hard copies of any supplemental material. Please note if your application passes the Strategic Fit Assessment you will be asked to provide further hard copies of the supplementary material.
Have you printed and signed the original application form? (electronic signatures are accepted). In addition to this have you sent 15 double-sided photocopies to Jacob Smith House, 7 Grove Park Court, Harrogate, HG1 4DP? Hard copies must also be received by the application deadline. If your application is successful in the Strategic Fit Assessment we will require you to provide additional hard copies.
Have you emailed a copy in Microsoft Word format to [email protected]? Application forms in PDF formats will not be accepted. Please name the file in the following format “[SURNAME] - 2017 FULL APPLICATION”.
Please do not submit an application if you answer “no” to any of the above questions. If you do not receive an acknowledgement within 7 days of submitting your application please
contact [email protected] or phone 01423 501269.
24Registered Charity: 516898. Yorkshire Cancer Research is a company limited by guarantee registered in England, number 1919823.
Registered Office: Jacob Smith House, 7 Grove Park Court, Harrogate HG1 4DP