Application FORM for Resarch Call

Application FORM for Resarch Call

HSE Research Awards on Ageing
ApplicationForm, May 2017
ESSENTIAL INFORMATION FOR APPLICANTS
Please read the Guidance Notes for the 2017 HSE Research Awards on AgeinginFULLbefore 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
  • EnsureALLrelevant documentation / signatures are provided as outlined in the submission checklist overleaf
  • Applications should be submitted by email to: 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 applicationfor 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 theapplication, the supporting documents and to obtain the required signatures before submission
  • Late or incomplete applications willNOTbe considered
  • For any queries about completing this application please email byFriday 25 August 2017. Queries received after this date may not be answered.

CHECKLIST FOR APPLICANTS

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

Checklist / Please tick to confirm
You 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
  1. Proposed project dates

Start date (can start no earlier than January 2018) / End date
(max. 24 months duration)
  1. 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 (Boxes4 –14)
  1. Lead Applicant: Principal Investigator

Name (including title)
Position
Will 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)

  1. Co-Investigator Number 1

Name (including title)
Position
Organisation/Faculty
Address
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)

  1. Co-Investigator Number 2

Name (including title)
Position
Organisation/Faculty
Address
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)

  1. Co-Investigator Number 3

Name (including title)
Position
Organisation/Faculty
Address
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)

  1. Co-Investigator Number 4

Name (including title)
Position
Organisation/Faculty
Address
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)

  1. CollaboratorNumber 1

Name (including title)
Position
Discipline
Organisation
Address
Email address
  1. CollaboratorNumber 2

Name (including title)
Position
Discipline
Organisation
Address
Email address
11. Collaborator Number 3
Name (including title)
Position
Discipline
Organisation
Address
Email address
12. CollaboratorNumber 4
Name (including title)
Position
Discipline
Organisation
Address
Email address
13. CollaboratorNumber 5
Name (including title)
Position
Discipline
Organisation
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 (Boxes15-27)
  1. Current knowledge and the research deficit that is being addressed (max. 1200words 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
  1. 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
  1. Aim of project (max. 100 words)

Please state the overall aim of the research project
  1. 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)
  1. Deliverables (max. 600 words)

Please describe the deliverables arising from each objective of the project
20.Design and methodological approach (max. 2000words)
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 thetheme of this call
24.Knowledge management (max. 300 words)
Please outline the plan for knowledge managementincluding: (1) knowledge translation and (2) knowledge transfer and dissemination
25.Ethical approval
Does 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 application
Have 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 considerationsfortheapplication 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 RESPONSBILITIESOF TEAM MEMBERS (Boxes 29 - 31)

Please see overleaf

HSE Research Awards on Ageing - Application Page 1

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 project
Work Package Number / Work Package Tasks / Role of Principal 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
1
2
3
4
5

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
1
2
3
4
5

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-1
Role / Collab-2
Role / Collab-3
Role / Collab-4
Role / Collab-5
Role / Time to be dedicated to this project in total days
1
2
3
4
5

*One day = eight hours

Please expand these boxes to meet the needs of your project

HSE Research Awards on Ageing - Application Page 1

32. Personnel newly recruited through the award (max. 300 words)
Where you have identified a candidate(s) to undertake this work, please include a CVfor each candidate (See Appendix6).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 award
Name, title and position of authorised signatory
Email address
Signature of authorised signatory
Date
Official Organisation Stamp
DECLARATION AND SIGNATURES OF APPLICANTS (Box 34)
34. Declaration and Signatures
In 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 Investigator
Co-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 individualswho 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 contacted
Name / Position / Organisation / Email
Reasons for nomination
Name / Position / Organisation / Email
Reasons for nomination
Name / Position / Organisation / Email
Reasons for nomination

HSE Research Awards on Ageing - Application Page 1

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

HSE Research Awards on Ageing - Application Page 1

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 NUMBER
CAREER 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 boldarticles where you are the lead author
SUCCESSFUL ACQUISITION OF EXTERNAL GRANT INCOME (max. one page)
Award Type / Start & end date of award / Title 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 Investigator

As the Principal Investigator I confirm, to the best of my knowledge, that the information provided in this application is correct

Name (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 / Months
Work Package
Number / Objective(s) / Task / Deliverable (s) / 1 / 2 / 3 / 4 / 5 / 6 / 7 / 8 / 9 / 10 / 11 / 12
1
2
3
4
5

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

APPENDIX5. COLLABORATOR AGREEMENT FORM
Collaborator
Name, 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
Consumables
Expert Advice

* Please edit the table as necessary to include all categories.

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