Supporting Research Capacity Building in Primary Health Care Program

AUSTRALIAN PRIMARY HEALTH CARE RESEARCH INSTITUTE

Supporting research capacity building in primary health care program

2014 APHCRI Foundation Grants

Application Form

Proposals must be received no later than5pm AEST, 8 August 2014.

Late or incomplete Proposals will not be accepted.

Submission of Proposals is not a guarantee of funding.

Applicants are required to submit the following:

Onesigned hard copy of the Proposal (i.e. the original with all attachments). This copy should be sent to:

MAILING ADDRESS:The Head of Programs

Australian Primary Health Care Research Institute

Building 63

Cnr. Mills and Eggleston Rd

The Australian National University

CANBERRA ACT 0200

COURIER ADDRESS:The Head of Programs

Australian Primary Health Care Research Institute

Building 63

Cnr. Mills and Eggleston Rd

The Australian National University

Acton ACT 2601

(02) 6125 0766

An electronic version of the Proposal, including all attachments, formatted as a single Adobe Acrobat PDF file. Electronic files should be emailed

QUERIES:Dr Chilandu Mukuka on (02) 6125 0782

AUSTRALIAN PRIMARY HEALTH CARE RESEARCH INSTITUTE

2014 APHCRI Foundation Grants

Eligibility Checklist

The following requirements apply to this funding round and ALL must be met:
The applicant has identified an administering institution, which is a legal entity and is either listed on the NHMRC Register of Administering Institutions or conforms to APHCRI’s requirements for administering institutions
The applicant has identified a Chief Investigator who will be the principle contact for all matters relating to the proposed work, and responsible for the accuracy of the information in this Proposal as well as ensuring the delivery of all contracted outcomes.
The applicant has identified a Research Administrative Officer (or equivalent) within the administering institution to be the administrative contact.
The administering institution has an Australian Business Number (ABN).
The administering institution holds public liability insurance.
The administering institution is willing to enter into a funding agreement with the Australian National University.
The applicant has read the draft Funding Agreement available on the APHCRI website and agrees to the terms and conditions.
Do not complete this form without referring to the information contained in the: 2014 APHCRI Foundation Grants Applicants document.

Proposal Lodgement

The Proposal must be submitted using this template
The closing date for proposals for2014 APHCRI Foundation Grants is 5:00 pm, AEST, 8August 2014.
Proposals are to be submitted as a single Adobe Acrobat PDF file (including the Application Form and requested attachments) in an e-mail addressed to ing the filename format surname lead investigator.initial(s) lead investigator.pdf (e.g. brown.mf.pdf)
You must submit one signed original Proposal and relevant supporting material.
All text in the Proposal should be 11pt Arial, single spaced.
Note: Fax copies and proposals exceeding the word limit will not be accepted.
Enquiries: Dr Chilandu Mukuka on (02) 6125 0782 or

SECTION 1 – Administrative Details
Chief Investigator A Name:
Position:
Postal Address:
Contact Numbers: (W) (Mob) (Fax)
Work Email:
Research Administrative Officer Name:
Position:
Postal Address:
Contact Numbers: (W) (Mob)(Fax)
Work Email:
Administering Institution Name:
Postal Address:
Is the administering institution GST registered?

Yes

No
* Administering Institution’s ABN:
(ABN= Australian Business Number)
** Your agreement to the Australian National University issuing a Recipient Created Tax Invoice:

Yes

No
* If your organisation does not have an ABN the Australian National Universityis required by law to withhold 48.5% tax.
** The Australian National Universityneeds your organisation’s permission to issue a Recipient Created Tax Invoice (RCTI). This is only relevant to organisations registered for GST.
Does the administering institution have current public liability insurance?

Yes

No
Funding is dependent on providing evidence of the administering institution’scurrent public liability insurance including the policy number and expiry date.

SECTION 2 – Project Information
Please tick the appropriate box/boxes below that best describe/s the nature of your proposal
(Choose one or more)

PHC Clinical research
PHC Health services research
PHC Systems research
Other (please specify)

ProjectTitle
Project Synopsis
Please provide a synopsis of your proposal that can be used for promotional purposes (eg. APHCRI website). Your synopsis should not exceed 300 words or half a page.
Project Description
Background and project description:Describe the background and significance of the project with particular reference to:

Identified existing gaps in current clinical or/and health services information
How the proposed research will address the gaps.
Identified existing projects (may include timeframes and funding levels where relevant) and how the existing identified projects link to the proposed research plan below.
Explain how the pilot research output/ outcome will be used with regard to effective implementation approaches suitable for broader implementation and transferability to relevant settings/systems
Demonstrate multidisciplinary and cross-sectoral involvement in the research
Demonstrate collaboration of experienced and early career researchers
Demonstrate how consumers and stakeholders will be engaged in research
Demonstrate collaboration with PHC organisations in the research

Aim of the research: Succinctly state the key research aims relevant to the chosen topic area. If relevant include a clear statement of the hypothesis to be tested.

Identify expected output/outcomes of the research and explain how the completion of the work will contribute to improvements in PHC services and health service information

Research plan: Outline the research pilot plan in detail including, as appropriate;

Detailed description of the research design, techniques to be used for data collection, methods of statistical analysis

Potential for future funding:

Demonstrate process and intent to apply for future category one/two funding

This should not exceed 2000 words or four pages.

SECTION 3 - Investigators
Details of the involvement of all Chief Investigators in this Proposal
In this section, all Chief Investigators are to be named and their roles and contributions specified.
The first named Chief Investigator A will be considered the contact point for the Grant and will be understood to be acting for, and in concurrence with, all Chief Investigators.
Surname / Title and Given Names / Role / % of time
A
B
C
D
Capacity
Demonstrate capacity to undertake the work by showing that in addition to relevant content knowledge the team has experience in:

primary health care policy, planning and implementation;
undertaking systematic reviews;
providing primary health care services

(To demonstrate this capacity, applicants will succinctly discuss relevant PHC policy, planning or implementation activities, past research, relevant publications, and experience for each of the team members).
This should not exceed 1000 words or two pages.
Chief Investigator A Details
A / Name
(Display name of Chief Investigator A, B, C etc as entered above)
B / Current job title
C / Current institutional address
Telephone 1 () / Telephone 2 ()
Facsimile () / Email
D / Date of Birth / Citizen
Permanent Resident
Other
Gender
Male Female
E / Most recent and highest Academic Qualifications
Year/s / Qualification / Institution
F / Current Appointment/s
Position / Institution/Organisation
G / Source/s of current salary
(i) / Duration of salary support
(ii)
H / Attach a list of publications relevant to this project Proposal from 1 January 2009 onwards / Check
I / Attach a brief CV showing previous appointments, information concerning other research outcomes, and non research activity relevant to policy and practice (not longer than 2 pages) / Check

Signature of Chief Investigator A

In signing this page, you certify that all details given in this Proposal are correct and you agree to carry out the project in strict accordance with the current APHCRI conditions of award, and that at least one named CI will attend all research workshops.

Signature:

Please print your full name: / Date:
/ /2014
Chief Investigator B Details
A / Name
(Display name of Chief Investigator A, B, C etc as entered above)
B / Current job title
C / Current institutional address
Telephone 1 () / Telephone 2 ()
Facsimile () / Email
D / Date of Birth / Citizen
Permanent Resident
Other
Gender
Male Female
E / Most recent and highest Academic Qualifications
Year/s / Qualification / Institution
F / Current Appointment/s
Position / Institution/Organisation
G / Source/s of current salary
(i) / Duration of salary support
(ii)
H / Attach a list of publications relevant to this project Proposal from 1 January 2009 onwards / Check
I / Attach a brief CV showing previous appointments, information concerning other research outcomes, and non research activity relevant to policy and practice (not longer than 2 pages) / Check

Signature of Chief Investigator B

Signature:

Please print your full name: / Date:
/ /2014
Chief Investigator C Details
A / Name
(Display name of Chief Investigator A, B, C etc as entered above)
B / Current job title
C / Current institutional address
Telephone 1 () / Telephone 2 ()
Facsimile () / Email
D / Date of Birth / Citizen
Permanent Resident
Other
Gender
Male Female
E / Most recent and highest Academic Qualifications
Year/s / Qualification / Institution
F / Current Appointment/s
Position / Institution/Organisation
G / Source/s of current salary
(i) / Duration of salary support
(ii)
H / Attach a list of publications relevant to this project Proposal from 1 January 2009 onwards / Check
I / Attach a brief CV showing previous appointments, information concerning other research outcomes, and non research activity relevant to policy and practice (not longer than 2 pages) / Check

Signature of Chief Investigator C

Signature:

Please print your full name: / Date:
/ /2014
Chief Investigator D Details
A / Name
(Display name of Chief Investigator A, B, C etc as entered above)
B / Current job title
C / Current institutional address
Telephone 1 () / Telephone 2 ()
Facsimile () / Email
D / Date of Birth / Citizen
Permanent Resident
Other
Gender
Male Female
E / Most recent and highest Academic Qualifications
Year/s / Qualification / Institution
F / Current Appointment/s
Position / Institution/Organisation
G / Source/s of current salary
(i) / Duration of salary support
(ii)
H / Attach a list of publications relevant to this project Proposal from 1 January 2009 onwards / Check
I / Attach a brief CV showing previous appointments, information concerning other research outcomes, and non research activity relevant to policy and practice (not longer than 2 pages) / Check

Signature of Chief Investigator D

Signature:

Please print your full name: / Date:
/ /2014

Associate Investigator Details

(A) / Title / Given name/s / Surname
Institution / Department / Position
Telephone / Facsimile / Email
Qualifications
Role in the proposed research / Hours to this project
Signature:

(B) / Title / Given name/s / Surname
Institution / Department / Position
Telephone / Facsimile / Email
Qualifications
Role in the proposed research / Hours to this project
Signature:

SECTION 4 – Budget
In this section, applicants should give detailed information regarding their budgets by completing both the table and the justification for the budget.
A fixed total of up to $50,000 will be provided for each project over twelve months. Acceptable expenditures of these funds, to be itemised below include:

Salary support (NOTE that APHCRI will not provide salary support for staff already in receipt of institutional salary for ‘buying out’ of administrative, teaching, or other time for staff engaged on the APHCRI grant).
Direct research costs
Support for multi-institution collaboration using the most economical means (travel, teleconference, etcetera)
Support for consumer engagement
Support for knowledge translation and exchange (including reasonable research travel for investigator and stakeholders)
Consultation with service provider/s as required, including venue hire, catering and related expenses

APHCRI does not provide funding for University overheads.

Budget Items:

(1) PERSONNEL (CIs, Research Assistants, Admin. Assist. Specify positions, level, time commitment)
Eg (CIA Smith, Level B @ 0.05 FTE) / Annual Salary Rate / $
Sub Totals
(2) CONSUMABLES (eg. bibliography, office costs) / $
Sub Totals
(3) TRAVEL (travel/attendance at conferences will not normally be supported) / $
Sub Totals
(4)) CONSULTATION WITH TARGET GROUPS / $
Sub Totals
(5 PRODUCTION OF REPORT / $
Sub Totals
TOTAL BUDGET REQUESTED

DETAILED JUSTIFICATION OF BUDGET

SECTION 5 – Clearance Requirements
(a)Ethics Committee Approval required?
Yes No
If Ethics Committee approval is required then a statement of Ethics Committee processes is required, including:

The name of the Ethics Committee(s) from which approval was/will be requested; and
either the date of approval (with copies of the letter(s) of approval attached) or
the date by which Ethics Committee approval is considered likely to be obtained.

(b)Aboriginal and Torres Strait Islanders
Does the proposed research program have a major focus on Aboriginal and Torres Strait Islander Peoples?
YesNo
* If you have marked yes, please read the following:
All intervention based research proposals with a major focus on Aboriginaland Torres Strait Islander peoples must demonstrate how the intervention/ research will:

be sustainable within the community on an ongoing basis,
be transferable to other communities, and
include appropriate community participation in its initiation, implementation and evaluation.

More information on these criteria is available at:
Please outline (to a maximum of three pages/1500 words) how your research proposals will address these criteria.

SECTION 6
Certification
In this section, a person with the appropriate delegation within the administering institution certifies the administering institution’s support for the Proposal, and the Chief Investigator A certifies that the details within the Proposal are correct and that she/he will be the contact person for the Proposal.

Certification by the administering Institution’s Chief Executive Officer/ delegate or equivalent

This section provides legal support for the Proposal as coming from the administering institution.
If you are successful in gaining funding from APHCRI you need to recognise that there are certain expectations such as financial accountability, public liability insurance and project reporting requirements. This will be described in more detail in the letter of offer.
I certify that:

this organisation will make time available to undertake the research;
this organisation supports the Proposal, and if it is successful will provide basic infrastructure and project management support for the project;
all of the information provided in this Proposal is true and correct and any grant received will be used entirely for the purpose(s) for which it is approved; and
this organisation agrees to provide budgetary support to the project.

______Date: / /
Signature of Chief Executive Officer/delegate or equivalent
______
Name (please print) Organisation
Certification by Chief Investigator A
I certify that:

I am the author of the Proposal;
I will be the Chief Investigator A; and
I am responsible for providing reports to the Australian Primary Health Care Research Institute.

______Date: / /
Signature of Chief Investigator A
______
Name (please print) Organisation/Unit

Final Checklist

Tick

Is the form complete and the declaration signed?
Have you provided one single Adobe Acrobat PDF File (including Application Form & Attachments) in the requested format?
Have you attached all supporting material (eg. Publications lists, CVs)?
Have you attached a copy of your current public liability insurance or quote for public liability?
Have you kept a copy of this Proposal and supporting material for your records?