Application Form for PhD Studentship (or equivalent*) Grant

Please type throughout and email application to Sue Maridaki -

AND submit original c/o the Royal Free Charity office.

Deadline: 5th December 2016

NOTE: The Trust will consider granting 3 year studentships submitted by prospective PhD supervisors. The maximum award granted for a project will comprise the following:-

a) An annual full-time postgraduate student stipend as follows:

Sept 2016/17 = £18,000; Sept 2017/18 = £18,250; Sept 2018/19 = £18,500.

(The stipend is tax free to the student and the sponsor does not incur NI or superannuation costs)

b) Consumables and associated costs up to £5,000 per year

c) UCL tuition fees at the annual UK/EU rate (£4770 in 2016/17)

NOTE: The Trust will also consider jointly funding a studentship for an approved project with another sponsor.

*Equivalent = MD or MS running costs and fees

1 Name of Principal SupervisorTitle/Position

2 Name of Second SupervisorTitle/Position

3 Name of proposed PhD (or equivalent) student

(if known at time of application, or state ‘Not yet known’)

4 Address of department and institution where the research will be conducted

Telephone No.

5 Title of Project

6 Abstract of Project

7 Layman’s Summary of the Project (100 words)

8 Proposed Starting Date

9 Summary of Grant requested Year 1Year 2Year 3Total

Cost: student stipend

Cost: consumables,

equipment,

other expenses

(total of £5,000 pa max.)

Cost: UK/EU PhD tuition fees

Total Grant requested

9Support from other sources

Is this application currently being submitted elsewhere, either for full or part funding? Yes/No

If yes, what percentage, and to which organisation? When is the result expected?

10Have you received assurances that any co-operation you will require from your own and other authorities in the conduct of the proposed research will be forthcoming? Yes/No

If yes, please attach copies of letters of confirmation.

11aPlease list below any other grants you currently hold for research related to this project, showing the title of the project, the scale of support, the name of the supporting organisation and the estimated duration of the project.

11bWhy are you approaching St Peter’s Trust rather than any other organisation?

12Animals

Are animals to be used in the project?Yes/No

If yes, a copy of the Home Office Licence must be provided before final approval of the project is granted.

13Is the proposed research likely to lead to patentable or commercially applicable data or apparatus? Yes/No

If yes, please give details

14Previous Grants from St. Peter’s Trust

If you or your supervisorhave been a recipient of a grant, or grants, within the past 5 years, please complete the following:-

Title of project

SPT reference number and name of grant holders

Start and completion dates

Publications arising from the project

Relevant interim/final reports have been submittedYes/No

PLEASE NOTE: if interim or final reports on previous St Peter's projects from your department have had not been received, no further grants will be given

15Description of the proposed Project

Continue on additional pages as necessary. Not more than 4 pages. 12 pt. font to be used.

Give details under the following headings:

a) Objectives

b) Background and rational

c) Plan of investigation

d) Timetable

e) Reasons for support requested

16Approval by the Head of Department/Division

The proposed research work has my approval. The work to be carried out can be accommodated in and administered by the Department.

Signature ______Date ______

Name and initials

(Typescript/capitals) ______

Approval by Chair of Research & Development Directorate of the relevant Hospital Trust and its Ethics Committee

This proposal was approved by the Research and Development Directorate of the

(name) ______Hospital Trust and its Ethics Committee

Signature ______Date ______

Name and initials

(Typescript/capitals) ______

Acceptance of terms and conditions by applicant

If my application is successful I agree to abide by the St. Peter’s Trust terms and conditions for grants, a copy of which has been supplied to me.

Signature of Applicant ______Date ______

Royal Free Charity Pond Street, London NW3 2QG

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