Application form

Project title
Abbreviated title
Field of research
Expected start of project, if already started please specify when it started
Project duration, if already started please mention total duration and remaining duration
Total budget of the project in CHF
Amount requested from the Research Fund of the Swiss Lung Association in CHF. If the amount requested is lower than the total budget, make sure the explication emerges in point 6 of this application form.
Synopsis of lay summary
(see document B1_Lay summary)

Project proposal is eligible for the open procedure (Type 1)

Project proposal is eligible for the topic specific procedure (Type 2)

1. Main applicant
Surname, first name
Date of birth
Current position / function
Academic degree / title
Institution, address
Phone / mobile phone no.
E-mail

Place and date ……………………………………...... … (Submission deadline: March 17th 2017)

Signature of main applicant………………………………………….…

Please sign and scan the complete application (PDF) and submit it with all necessary attachments (the Lay Summary as a document in MS-Word) via e-mail

2. Co-applicants
1.Surname, first name
Date of birth
Current position / function
Academic degree / title
Institution, address
Phone / mobile phone no.
E-mail
2.Surname, first name
Date of birth
Current position / function
Academic degree / title
Institution, address
Phone / mobile phone no.
E-mail
3.Surname, first name
Date of birth
Current position / function
Academic degree / title
Institution, address
Phone / mobile phone no.
E-mail

3. Projectdescription

(Precise overview, max. 6pages with the exception of bibliography references)

3.1Research question and problem statement / scientific significance

3.2Current state of research in the field (background, literature references)

3.3Expertise and qualification of the applicant(s) and/or the research team regarding the field of study, pilot study if applicable.

3.4Research objectives, justification and proof of originality

3.5Detailed research plan and study protocol (methodological approach, design, setting, quantity structure, data availability, method of data analysis, etc.)

3.6Schedule (Planned start and duration of the project, milestones)

3.7Does your research project involve cooperation with another institution? Yes  No 

Please take note that in the case that the Swiss Lung Association will support your project, such agreement has to be signed prior to the signature of the agreement with the Swiss Lung Association.

3.8Does you research project needs an approval from the Ethic Committee? Yes  No 

If yes, have you already received the authorization? Yes  No 

If no, have you already applied? Yes  No 

Please take note that in the case that the Swiss Lung Association will support your project, you have to have received such approvals prior to thesignature of the agreement with the Swiss Lung Association.

3.9Does your research project involve human and/or animal experimentation?

Human experimentation: Yes  No 

Animal experimentation: Yes  No 

If yes, has the Swiss Ethics Committee on research involving humans and/orthe Ethics Committee for Animal Experimentation approved your request?

Human experimentation: Yes  No  Waiting for an answer 

Animal experimentation: Yes  No  Waiting for an answer 

If your project involves human and/or animal experimentation, please describe how and why?

3.10Expected results, broader impact and its scientific relevance

Location(s) of project (institute, clinic, laboratory):

4. Financing (Justificationofthe requested amount)

Budget / 1st year / 2nd year / 3rd year / Total
Salaries and social security contributions*:
Name/first name, acad. degree / Workload
Equipment costs, consumables
Subsistence expenses (travelling costs, printing costs etc.)
Additional expenditures
Total

*The main applicant is not allowed to apply for his own salary, but will apply for the salary of his/herteam. The salaries must include the wage-based, social security contributions which are mandatory in Switzerland: state pension schemeand invalidity insurance (AHV/IV/EO), unemployment insurance (AVIG), health and accident insurance (KVG/UVG).

If applicable, enter the percentage of the employer's contributions of your institution, excluding possible further contributions such as for children or family allowances.

5. Resources already available for the project

Personnel
- medical staff
- laboratory staff
Operational budget
- of hospital
- ofuniversity
-othersources
Premises, laboratory
equipment

6. Did you apply for project support at other funding organisations?

yes / no / requestedamount (CHF) / awarded amount (CHF) / refused / pending
-Swiss National Science Foundation (SNSF)
If pending, date on which you should receive the decision
-University
If pending, date on which you should receive the decision
-Other financiers:
If pending, date on which you should receive the decision
Name:
Name:
Name:
Explanations*:

*The main applicant accepts the ethical principles and guidelines of the Swiss Academy of Medical Sciences (SAMW) and the Swiss law on human research (“Humanforschungsgesetz”, SR 810.30). In case of conflicting interests, the applicant is obliged to describe the nature of the relationship and any possible material benefit or support from the relationship (self-declaration).

The Research Fund of the Swiss Lung Association does not accept any projectproposalfromapplicants who have or have had any direct or indirect links with the tobacco industry, such as former funding from, the holding of sharesin, speaking at or attending meetings organised by the tobacco industry.

Declaration

I declare that I have or have had NO relationship of any kind with the tobacco industry.

Signature of main applicant:Date:

……………………………………………..…………………………….

7. Data protection principles and conditions

The Research Fund of the Swiss Lung Association will treat all personal and application data confidentially. The Research Fund will pass on such data only with the written permission of the applicant or on the basis of a court order.

The applicant agrees to pass the application for assessment purposes on to members of the Research Committee or to experts on behalf of the Research Committee. The Research Fund is not obliged to inform the applicant about this internalexchange of data.

The applicant gives permission to the Swiss Lung Association and its Research Fund to publishthe Lay Summary (see document B1) including the project title,the names of the researchersandtheir institutions as recipients of project grants.

The applicant is obliged to indicate the support received from the Research Fund of the Swiss Lung Association LLS on all publications incl. posters, presentations, etc. in the following manner:

“This project was supported by the Research Fund of the Swiss Lung Association.”

The applicant accepts the decision of the Research Committee and will not take any legal action in this matter.

Please send the signed application as a PDFwith all the necessary attachments as a zip file via e-mail to:

Mandatory attachments:

Lay summary to be written in English as a separate document in MS-Word (see document B1_Lay summary)

CV of the main applicant includinga list of his/her most important publications (max. 3pages) and a separated JPG, 300 dpi. portrait photo

Short CV of the co-applicants including a list of five publications that are relevant to the project

Copiesof funding decisions by the SNSF or other organisationsconcerning this project

Optional attachment:

Letter of support (mentoring)

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