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Research Programme Application (PA215)

Coversheet

HRC Ref ID#:Click here to enter HRC Ref ID#

NI:Click here to enter surname

Research Investment Stream:Click here to enter RIS

Computer used to complete this form:Click here to enter Windows or Mac.

This page is for identification purposes only. It will be replaced by the online pages in the final submitted application.

In the pdf version of this document Module 2 must begin on a new page.

Hints for adding content to forms

This form was developed in MS Office 2013.

Form fields have Arial 10-point font as default although bold and underlined variations are acceptable.

Develop draft information in a separate document and then copy into this form. The draft should use Arial 10-point font to avoid formatting problems.

Referencing with Endnote may not function in this form in which case copy Endnote lists as text only.

The CV must be in Arial 12-point font.

IN CONFIDENCE

MODULE 2: RESEARCH

Section 2A – Summary of Research Programme (one page)

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Rationale for Research

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Aims

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Research Design and Methods

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Research Impact

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Section 2B – List of Proposed Research Objectives

List the proposed research objectives or projects within the Programme and the Name Investigators leading these parts of the Programme.

Objective or Project Title
(80 Characters maximum) / Leading Named Investigator
(Surname, Initial)

Section 2C – Description of Proposed Research Programme (15 pages maximum)

1. Describe the list research objectives or projects and how they form a cohesive theme of research (use diagrams as appropriate). For each component, the rationale, design & methods, impact against Investment Signal goals, and research team track record should be covered.

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2. The long-term goals of the research group as they relate to the HRC Research Investment Streams and Signal goals.

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3. The collaborative nature of the research. Collaboration with other research groups, both nationally and internationally, and if appropriate, liaison with health services providers and the health policy development process.

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4. The staffing, management and organisation of the research programme, including administrative mechanisms, resource and financial management.

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5. The training opportunities for young investigators that exist or will be developed within the programme.

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6. The level of support and facilities provided by the host organisation.

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7. The research group’s productivity and likely impact on improving human health.

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8. The group’s policies and practices for the dissemination of research results.

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9. The research group’s policies and general activities with respect to responsiveness to Maori as it relates to health and/or health research.

How might your research contribute to the health needs of Māori? What is the health significance and context of this research to Māori? Discuss the incidence or prevalence in Māori, or indicate if not known to be significantly different from the general population. Have you sought advice for the study from a Māori researcher/representative (if applicable)?

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MODULE 3: REFERENCES

Click here to enter text.There is no limit to the number of reference pages. Asterisks are to be placed beside applicants’ publications. Provide references in full and state full authorship (for example not Smith et al). Endnote lists should be copied into a plain text editor before pasting in here.

MODULE 4: CONTRACT INFORMATION AND BUDGET

Use the HRC Excel Spreadsheets ‘HRC215budget.xls’ for Sections 4A-4D.

For the paper copy of the application

Attach a printout of the spreadsheet Sections 4A-4D (Contract Information (Objectives and Milestones), Budget, MOU Budget(s) and FTE Summary) after this page of the application form.

Ensure any page breaks are logically placed to facilitate review.

For the electronic copy of the application

Upload the Excel file to the HRC Gateway using the required file formats (.xlsx and .pdf).

Section 4A – 4D Contract Information

Section 4E – Justification of Expenses

Justification of Research Staff (as listed in budget)

Click here to enter text.Justify the role of all staff (named and unnamed). Unnamed postdoctoral fellows should also be justified here, but unnamed PhD students will be disallowed. “Staff” may include research assistants, technicians, medical staff, interviewers, support staff or similar, whose names or position titles are listed in the budget under “Research Staff” and who have specific FTE involvements. Clearly state if staff will be promoted during the Programme, or the annual salary inflation will automatically be capped to 3%.

Justification of Working Expenses and Casual Staff (as listed in budget)

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Section 4F – Previous / Current Contractsand Awards

List Previous / Current Contracts awarded within the past 5 years.

Copy and paste additional tables if required.

Funding agency
Title of research
Investigators
Start date and duration
Total value
Nature of support (1 sentence)
If HRC contract (HRC Ref #), was Final Report filed? If not, why?
Funding agency
Title of research
Investigators
Start date and duration
Total value
Nature of support (1 sentence)
If HRC contract (HRC Ref #), was Final Report filed? If not, why?
Funding agency
Title of research
Investigators
Start date and duration
Total value
Nature of support (1 sentence)
If HRC contract (HRC Ref #), was Final Report filed? If not, why?

Previous HRC Final End of Grant Report(s)

List here and upload the pdf version of all previous HRC final end of grant reports (from the Annual Funding Round and Research Partnership contracts) from the past 5 years (for senior Named Investigators) using the HRC Gateway.

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Section 4G – Other Support

Other Research Applications Awaiting Decision

Yes / No
Are any named investigators on this programme also named investigators on a project application? (Y/N)
If yes, is the project a component of this programme application such that the Project will be considered withdrawn if the Programme is fully funded?(Y/N). Provide HRC Ref #
If no, then in the area below identify the Project, briefly outline its area of research and clearly explain how your Programme is separate from it.

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Applicants must advise the HRC of the outcome of other research applications through their Research Office.

Copy and paste additional tables if required.

Funding agency
Title of research
Investigators
Start date and duration
Total value
Date of outcome
Areas of overlap with this Application. HRC Ref #?
Funding agency
Title of research
Investigators
Start date and duration
Total value
Date of outcome
Areas of overlap with this Application. HRC Ref #?
Funding agency
Title of research
Investigators
Start date and duration
Total value
Date of outcome
Areas of overlap with this Application. HRC Ref #?

Co-Funding

What other agencies or end-users have been approached or committed to joint or partial funding of this research?

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Financial Interest(s)

Do you or any named investigator have a financial interest related to the research or sponsorship of the research?

Yes / No
Financial interest?

If yes, outline below and provide details of your conflict management strategy.

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Section 4H – Letters of Collaboration/Supporting Documents List

List all memoranda of understanding or sub-contracts, letters of collaboration (which outline material or actual support) and supporting budget documents. Refer to the Guidelines for instructions about how to attach these documents.

Referees and Science Assessing Committee members will see the list below and documents will only be made available on request.

Note that Appendices are not permitted.

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List of Collaborators (National and International)

Please list all collaborators associated with this project

Collaborator Name / Organisation / Country / Purpose / Support (NZ$ or in-kind)
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MODULE 5: NZ STANDARD CV

Click here to enter text.Copy and paste the CVs for all staff that will contribute to this research. Ensure that all names in CVs are identical to those listed in Module 1 or the application may not be processed.

CV Guidelines must be followed. Rows and columns may be expanded or reduced, but a CV must be no more than two pages for Part 1 and no more than three pages for Part 2. Use Arial 12 point font. Do not alter page margins. Instructions in italics should be deleted before you submit your CV.

Ensure that publications are listed in full (with full authorship).

MODULE 6: ADMINISTRATION

This Module will only be required from successful applicants offered a contract. It is provided here for reference only. No signatures are required. The full administration agreement can be downloaded from the HRC website.

Section 6A – Ethical and Regulatory Agreement

The applicant has read the ‘Guidelines on Ethics in Health Research’ and ‘Te Ara Tika - Guidelines for Maori Research Ethics: A framework for researchers and ethics committee members,’ available from the HRC website and agrees to abide by the principles outlined in them. The undersigned also agrees to provide written evidence before any research procedures commence, that in any study involving animal or human subjects, animal or human materials or personal information, a properly constituted accredited Ethics committee (a list of currently accredited Ethics Committees is available on the HRC website) has examined and agreed to the ethics of the proposal outlined in this proposal. If minor changes in the research design or procedures have been required for ethical reasons, the HRC must be informed of them. The undersigned also undertakes to ensure that all regulatory consents are gained before research commences. For further information regarding the ethical approval process, please contact the Secretary to the HRC Ethics Committee, , or the appropriate accredited Ethics Committee.

Section 6B – Administrative Agreement

All HRC applications must include an undertaking to abide by the following administrative agreement:

1.It is understood and agreed that this application and any contract awarded as a result of this application is subject to the Health Research Council of New Zealand Rules (“Permissible Use of Research Funding and Operation of Contracts”). Funds will not be expended for any other purpose than described in this application.

2.The host institution agrees and undertakes to bear all risk and claims connected with any operation covered by this application and to indemnify and hold harmless the Council against any and all liability suits, actions, demands, costs or fees on account of death, injuries to persons or property, or any other losses resulting from or connected with any act or omission performed in the course of the research.

3.The host institution agrees and undertakes to support for the duration of any contract, the work described in this application by making available accommodation, basic facilities for research and the services necessary for its fulfilment.

4.The Head of Department agrees to accept this research within his/her department if a contract is made, agrees to provide workload relief for research staff working on this contract (Principles of Full Cost Funding), and is aware that s/he may be requested by the HRC to provide a confidential assessment of the research during the term of the contract.

5.The host institution official designated below agrees to ensure that the research will have been approved, where necessary, by the appropriate institutional biosafety committee and/or all other required regulatory agencies before research is commenced.

6.The applicant(s) agrees to allow specified personal information to be used for statutory and publicity purposes.

7.The host institution has in place policies and processes to ensure that consultation with Maori has occurred and the application is responsive to the needs and diversity of Maori.

We the undersigned have read the above administrative agreement and undertake to abide by the conditions of this agreement in respect of any contract made by the Health Research Council of New Zealand as a result of this application. We the undersigned confirm that the information provided in this application is to the best of our knowledge true, that all sections are correct at the time of application submission, that each NI agrees to the stated FTE% contribution and that funding to any NI from any source will not exceed 100 FTE%.

MODULE 7: RESEARCH CLASSIFICATION

Section 7A – Australian and New Zealand Standard Research Classification (ANZSRC)

This Module is for evaluation purposes only and is mandatory; incomplete applications will not be processed.

Applicants are required to categorise their research using the ANZSRC codes. A maximum of 3 for Fields of Research and a maximum of 3 for Socioeconomic Objective classifications found on the HRC web link ( – find the appropriate 6-digit code(s) and description and enter both code AND description(s) below. Weighting % entered to nearest 10% and totals to 100%.

Research Descriptors
Fields of Research (FOR) / Weighting (%)
Socioeconomic Objective (SEO) / Weighting (%)
Keywords

Section 7B – Economic Benefits

This information is required for reporting to government and so is mandatory. Incomplete applications will not be processed.
Describe the economic benefits that may arise from the research, or state if the economic returns will accrue from health benefits.If no direct economic benefits are anticipated, state this rather than leaving the field blank.
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IN CONFIDENCE