APPLICATION FOR RESEARCH GRANT FUNDING (SERTA MONEYS)

2017 Round 1

Townsville Hospital and Health Service

Cover Sheet - Application for Research Grant Funding
***Please note this is a cover sheet/checklist only. All supporting documentation must be provided with the Application Form.
Project Title
Chief Applicant (CA) Name
CA position and Service Group at THHS
CA contact email
CA contact phone no
Participants to be studied in project
Ethics Approval / Yes / No
If YES, HREC/AEC Ref No: / Date of approval:
THHS Research Governance Authorisation / Yes / No
If YES, THHS RG Ref No: / Date of authorisation:
Staff to be Hired for Project / Yes / No (If Yes please provide details on the application form)
Total Project Cost
Total Funding Amount Sought
Length of project (yrs)
Length of time funding sought (yrs)
Institutions /sites to be involved in the project

The applicant(s) have read and considered the mandatory Terms and Conditions of the funding, and the applicant(s) agree to abide by these and any other conditions or requirements as advised by the Research Education, Support and Administration Unit in writing. The Applicant(s) must sign below to evidence support of this Application and agreement to abide by the Terms and Conditions:

Name / Signature / Date

Add additional rows for names and signatures as required – the Chief Applicant and all co-applicants must sign. All co-applicants are to be identified in Question 13

The following positions must sign below to evidence support for this Application:

Chief Applicant Head of Department Name / Signature / Date
Service Group Director Name / Signature / Date

Grant round opens: Monday 6th February 2017

Grant round closes: Sunday 5pm 2nd April 2017

Please submit both a pdf and Word version of the completed application to:

. A hard copy is not required.

THHS SERTA Research funding application 2017 Round 1 Page 1 of 6

Townsville Hospital and Health Service

RESEARCH FUNDING (SERTA MONEYS) APPLICATION FORM

Introduction

This Application Form is designed to assist the applicant in providing the information that the Research Trust Fund Advisory Committee (RTFAC) expert panel (Research Merit) and the Research Trust Fund Advisory Committee will need to assess the Application.

Information must be inserted into the expandable table cells provided below. In each of these cells, some guidance is provided, suggesting the minimum information the Committee will require. Applicants should provide the information where it is appropriate, in an effort to maximise funding potential.

Please use a size 11 Arial font when completing the application.

Word limits are included in some sections. Information beyond these word limits will not be considered.DO NOT delete any questions or rows

Delete all information in RED before submitting your application

Application

Insert the project title. The project title should match the title you will use for your HREC/AEC application
  1. Project title:

Please state the anticipated timeline for your project.
  1. Timeline for Project:

  • If not HREC/AEC approved, state anticipated HREC/ AEC submission date:

  • If not THHS authorised, state anticipated THHS RG submission date:

  • Anticipated /actual commencement date of project:

  • Anticipated completion date of project:

In no more than 700 words, please provide a concise summary of the current knowledge relating to the research, stating the importance of the proposed research for advancing new knowledge, and identifying thesignificance of the research. Include any consumer; community consultation. Provide up to 5 key references at the end of the application(Question 14)
  1. Project Background and rationale:

In no more than 700 words, please list the research aims and objectives and provide a concise and robust description of the research design. The description should include but not be limited to: the methodology to be used, hypothesis, sample size, actions required, data to be collected.
  1. Description of study:

In no more than 500 words provide a description of the expected outcomes of the study. For example the potential clinical impact of the project, how the study may assist in resolving existing clinical problems and in what way clinical practice may change as a result.
  1. Expected outcomes of the project and impact:

Please describethe data analysis plan.
  1. Data analysis plan:

Please provide the total amount of funding requested and a detailed budget breakdown of costs, including when these costs will be required throughout the project. If funding is requested for research staff the application must state the employment stream and level; the FTE; length of employment and must include provision for all on costs. Please explain exactly how the grant monies will be used and why the amount requested is appropriate and justified.Please describe support to the project (if any) from other THHS internal sources e.g. internal in kind departmental support.
  1. Provide a detailed budget breakdown of the costs involved with your project and how will you spend the grant money:

Please explain how the project contributes to THHS organisational objectives including safety, quality and effectiveness and how this project aligns with THHS strategy of development or how it promotes the THHS priorities and objectives. Please describe the contribution this study will make to the strategies and objectives of the THHS Strategic plan:
  1. Project alignment with the THHS Strategic Plan and organisational objectives:

In no more than 250 words, please outline a proposed plan to translate the research findings and expected outcomes described in Question 5
  1. Potential Knowledge Translation Plan/Strategy:

Please explain the plans that the research team has to use the results achieved via this grant in making a further application for external grant funding e.g. is this a pilot feasibility study; the results of which will be used for a larger grant funding application?Please describe support to the project (if any) from external sources e.g. co-funding. What other support has been applied for and the results of these applications?
  1. Ability/plan to leverage external funding:

Please provide information regarding the Chief Applicant’s knowledge, skills, availability, and capacity to undertake the proposed project.The Chief Applicant must be an employee of the Townsville Hospital and Health Service (THHS). Please ensure if you will not be a THHS employee for the length of the grant that you have a THHS employee as a co-applicant who will be a THHS employee for the duration of the grant.
  1. Chief Applicant

Name:
Time commitment to the project:
Experience relevant to the research:
Novice researcher refers to the researcher’s research experience, not their time as a clinician.A novice researcher must not be the nominated Chief Applicant of another research project (completed and/or current), be a co-applicant on five (5) or more research projects (completed and/or current) or have attained a research higher degree (including MPhil, PhD or professional doctorate). Note: An employee currently undertaking their research higher degree will be considered a novice. Novice Researchers are required to have a Research Mentor as a co-applicant who can support them in the conduct of the research.
Novice researchers are strongly encouraged to apply for funding
  1. Chief applicant novice researchers

  • Is the Chief Applicant a novice researcher?
YES NO
If no, go directly to Question 13.
  • Is this project being conducted as part of a degree undertaken by the Chief Applicant?

YESNO
  • If a novice researcher, identify which of your co-applicants will be your research mentor for this study:

Please provide information regarding the Co-Applicants’ knowledge, skills, availability, and capacity to undertake the proposed project.A Co-Applicant is a research team member involved in the development and or execution of a project. A co-applicant typically devotes a specified percentage of time to the project and is considered senior/key personnel. The terms co-applicant, co-researcher and co-investigator are synonymous.
  1. Co-applicants

Co – applicant 1
Name:
Organisation and position in organisation:
Time commitment to the project:
Experience relevant to the research:
Co –applicant 2
Name:
Organisation and position in organisation:
Time commitment to the project:
Experience relevant to the research:
Co –applicant 3
Name:
Organisation and position in organisation:
Time commitment to the project:
Experience relevant to the research:
Co –applicant 4
Name:
Organisation and position in organisation:
Time commitment to the project:
Experience relevant to the research:
Co –applicant 5
Name:
Organisation and position in organisation:
Time commitment to the project:
Experience relevant to the research:
Add / delete rows as required
Add up to 5 key references relevant to Question 3
  1. References:

Research Funding Application (SERTA Moneys)

TownsvilleHospital and Health Service

Terms and Conditions

These Terms and Conditions are mandatory and apply to an application for research funding, and irrespective of whether the funding is approved and/or paid.

By signing this Application, the Chief Applicant/s (and Co-Applicants if applicable) (hereinafter referred to as the Applicant) acknowledge and agree that they have read and understood this Application, including these Terms and Conditions.

The Applicant agrees and acknowledges as follows:

  1. Any research funds granted or paid out of the research funds grant (‘the Grant’) must be used in accordance with the terms of the approval as notified in writing by the Research Education, Support and Administration Unit (‘the Approval’).
  2. Townsville HHS will only authorise payment of the Grant (or part thereof) in accordance with the timeline and purposes stated in the Application and as approved by the Research Trust Fund Advisory Committee.
  3. If human participants are involved in the research, approval from or formal exemption from review by the Townsville HHS Human Research Ethics Committee (HREC) or a National Health and Medical Research Council (NHMRC) certified HREC to review multi-centred research studies must be received before the Grant (or any part of) will be made available for the research project, unless part of the grant is awarded for the completion of the submission to the HREC.
  4. If animal participants are involved in the research, approval from or formal exemption from review by an animal research ethics committee must be received before the Grant (or any part of) will be made available for the research project, unless part of the grant is awarded for the completion of the submission to the AEC.
  5. Townsville Research Governance (RG) authorisation must be received before the Grant (or any part of) will be made available for the research project, unless part of the grant is awarded for the completion of the submission to the THHS RG.
  6. Any amounts paid out of the Grant by Townsville HHS will be recorded in a financial system specific to the approved research project to ensure the Townsville HHS can monitor expenditure of each project and to assist in reporting and ensure accountability and transparency.
  7. If the Applicant requests a variation to the Approval, the Applicant must apply to the Chair of the Research Trust Fund Advisory Committee.
  8. The Applicant must for the full duration of the project, provide a progress report on the project, including a budget acquittal report (template to be provided and available through the Research Education, Support and Administration Unit) for review by the Research Trust Fund Advisory Committee on the earlier of:

(a) Annually from the date the Grant was approved; and

(b) The date notified by the Research Education, Support and Administration Unit from time to time.

  1. The Applicant undertakes to keep the Research Education, Support and Administration Unit fully apprised of any change in circumstances which may or are preventing the commencement or continuance of the research project.
  2. The Applicant is responsible to comply with all Government and Townsville HHS applicable ethics, financial and administrative prerequisites and procedures.
  3. The Applicant must comply with all reasonable directions/instructions issued by the Research Education, Support and Administration Unit relating to the administrative prerequisites and procedures.
  4. The Applicant is responsible to ensure that any publications arising from the project is correctly attributed to the Townsville HHS and must acknowledge the Townsville HHS SERTA Moneys.
  5. If at the end of the project, the Applicant is holding the Grant (or any part thereof), the Applicant must return the Grant (or part thereof) to the Townsville HHS.
  6. The Applicant agrees to actively participate in research related events organised through Townsville HHS, including submitting an abstract for presentation at the Townsville HHS annual Research Symposium, as a means of increasing the profile of Research within the Townsville HHS and promoting research activities.
  7. In the event that the Applicant fails to comply with these Terms and Conditions or in the event that Townsville HHS consider that any part of the Application is found to be incorrect, false or misleading, Townsville HHS may, by written notice to the Applicant cancel the approval of the Grant and take such action as Townsville HHS consider appropriate.
  8. The Applicant agrees that to the extent permitted at law, the Townsville HHS owns any intellectual property associated with the project.

THHS SERTA Research funding application 2017 Round 1 Page 1 of 6