Application for the RDS YH Public Involvement Funds – CALL 32

Please email your completed application form to , stating ‘RDSYH Public Involvement Funds – Call 32’ in the email subject window.

Please complete the form as fully as possible and refer to the guidance notes. The points provided in the guidance notes may be helpful when structuring your answers. Please contact your local RDS office if you have any difficulties answering the questions on this form.

1.Name and details of lead applicant for RDSYH Public Involvement Funds
Full name
Job title
Organisation
Work address
Postcode
Telephone number
Email
Self-employed?
2.Please give the details of co-applicants (if applicable). Copy and paste the table below as needed
Full name
Job title
Organisation
3.Type of application
Project specific ☐ / Establishing a new panel ☐
4.Research Title/ Name of Panel:
5.Is this a resubmission?
Yes ☐ / No ☐
If ‘Yes’ please provide further details.
Call Number: / N/A ☐
Additional details:
6.Have you made contact with RDSYH regarding this application?
Yes ☐ / No ☐
If ‘Yes’ please give brief details, including who you have spoken to.
7.Please provide a plain English summary (no more than 750 words).
8.Please outline how you will actively involve members of the public in the development of your grant application(s):
9.Please outline how members of the public will be involved in your work after you have submitted your grant application?
10.Please outline how you will evaluate your PPI activities.
11.Please give details of the funding scheme(s) which you think your research grant application(s) may be sent to.
12.Please provide a breakdown of how the funds will be spent.
13.If applicable, please indicate other sources of contributory funding already obtained for this project.
Funding source:
Amount: / £
Please provide the name and contact details of the relevant finance officer in your organisation, whom the RDSYH will liaise regarding the payment of the award.
Name of finance officer
Address
Telephone number
Email address
DECLARATION (to be signed by the lead applicant for this award)
I confirm that to the best of my knowledge the information given on this form is correct. I understand that my name will be held on a database in accordance with the Data Protection Act, and that I may be asked to participate in future evaluations of this award scheme. If you are unable to provide an electronic signature then please print and sign a hard copy and return to the address in the guidance.
Signature: / Date:

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RDS YH Public Involvement Award Form_v2.2_26May2016