Application Type Select One Only

Section 1: Applicationsummary details

Application type[select one only]

Salary support only / Includes research expenses

Applicant details

Applicant name
Department/clinical service
Current supervisor/manager[Note 1]
Sponsor name[1]
Sponsor name[2]
Mentor name

Proposal summary details

Programme title[20 words]
Host institution / Moorfields Eye Hospital [MEH]
UCL Institute of Ophthalmology [IoO]
Funding requested / Salary support / Research expenses
Start date [dd/mm/yyyy]
Duration of support requested [months]
Budget summary / Salary support cost total / £
Research expenses total / £
Total costs requested / £
Summary for lay readers [Note 2]

Section 2: Classification of research programme

Area of research [select a maximum of two areas only]

Age related macular degeneration / Lens/cataract
Adnexal/extra-ocular / Neuro-ophthalmology/optic neuropathies
Corneal/ocular surface disease / Ocular cancer
Community health/patient support / Paediatrics
Diabetic retinopathy / Ocular inflammatory diseases
Genetics/inherited eye disorders / Ocular motility/visual processing
Glaucoma / Retinal/vitreo-retinal

Category of work [select one area only]

Pre-clinical/basic research
Translational research/proof of concept to phase IIa trials
Post phase IIa trials
Other (e.g. cross-over, patient welfare, healthcare services)

IoO-MEH joint research themes [select at least one]

Development, aging and disease
Rescue, repair and regeneration
Visual assessment and integrative epidemiology

NIHR Biomedical Research Centre themes [if work will involve the BRC, select one]

Gene therapy
Genomic medicine and informatics
Inflammation and immunotherapy
Regenerative pharmaceutics
Visual assessment and imaging

Section 3: Overview of application

Strategic fit statement [Note 3]
Impact and outcomes statement [Note 4]
Provide detail onhow the award would support and enable a move to the next level in your research career[Note 5]
Detail plans for seeking subsequent external funding support [Note 6]
Funding body / Scheme name / Full application deadline / Estimated decision date

Section 4(a): Details of research programme

Overview of current and future research programme including positioning/justification of current application[Note 7]

Section 4(b): Research Expenses request

This section should only be completed if you are also requesting funding for new, discrete and unfunded research. Applicants are advised to refer to the scheme guidance notes for additional information on what is expected in this section.

Briefly explain why the additional funding is required and not available from other current funding. Please also indicate who will be completing the work and their source of salary funding.
Aims and objectives [200 words]
Background relevant to theproposed research[1000 words]
Experimental design and methods [2000 words]
Statistical information/considerations[500 words]
Why is this proposed research and its design suitable and appropriate to gather preliminary data to underpin the development of a more substantial research project grant/activity[200 words]
References

Section 5: Budget details and justification

Related grant applications and/or awards [Note 8]
Complete Excel File Annex A and provide justification/brief description for all costs below

Researchexpenses/materials justification

Salary
Materials and consumables
Miscellaneous
Equipment/software
Access charges
Animals

Section 6(A): Applicant CV[2 pages maximum]

Applicant
Current post(s)
Current salary source(s)
Contract end date
Email address
Time spent on research / Time spent on this grant
Previously held posts (most recent first, maximum 3 entries)
Date from / Date to / Position / Organisation
Education and training (most recent first, maximum 3 entries)
Date awarded / Qualification / Subject / Organisation
Awarded grants and previous applications to Moorfields Eye Charity [Note 9]
Awarded grants from other funders [Note 10]
ORCID ID[Note 11]
Publications [Note 12]

Section 6(b): Additional CV information

Summary of research/scientific career to dateincluding key achievements, recognitions, and any other relevant career experience. This question allows the opportunity to expand on your achievements that are not listed elsewhere in the application.
Provide details of up to three of your publications, which you consider the most significant or relevant to the application.
Please explain your selection and highlight your role within each study.
What new collaborations do you intend to develop/expand during the time of this grant?
New techniques, skills and career development training plans. Provide details of any training courses, skill development specifically needed to achieve the research outlined and to enhance and expand more general career development skills.
Where appropriate, how does your research, outlined in this application, fit within that of your current supervisor/group’s work.

For medical or allied health professionals

Training status

Please indicate whether you are a medical orallied health graduate
Please describe what, if any, the clinical duties that are essential for the delivery of the proposed research and the number of hours per week that will be spent undertaking these.
Please state the number of hours per week that will be spent on ‘routine’ clinical work or that is needed for further training requirements
Please provide details of what these ‘routine’ clinical duties will involve
Where (clinic, site) will this routine clinical work be based?
What level of clinical contract do you currently hold?
Please state your chosen clinical speciality, if relevant and known.
What progress, if any, has been made towards accreditation in your chosen speciality?
What level of clinical contract will be sought during this award?

Professional body registration

Please state which regulatory body or council you are registered with
Please give your General Medical Council (GMC) number or the relevant registration number for your profession if an allied health professional
Do you have a National Training Number?
What is your current stage of clinical training?
Do you hold a certificate of completion of training (CCT)? / Yes / No
If yes, please state date awarded

Section 7: Sponsor details[2 pages maximum]

Duplicate page as required for a maximum of 2 sponsors. A letter of support should be provided by each sponsor.

Sponsors name
Current post(s)
Location [name/address]
Contract end date
Email address
Time spent on research
Previously held posts (most recent first, maximum 3 entries)
Date from / Date to / Position / Organisation
Education and training (most recent first, maximum 3 entries)
Date awarded / Qualification / Subject / Organisation
Awarded grants and previous applications to Moorfields Eye Charity [Note 9]
Awarded grants from other funders [Note 10]
ORCID ID[Note 11]
Publications [Note 12]

Section 8: Mentor details

Mentor name
Location [name/address]
Current post(s)
Email address
Statement of support [max 500 words]

Section 9: Additional information

Data management and sharing statement [Note 13]
Research involving human participants and/or animals
Will your project involve use of animals? If YES, complete Annex D / Yes/No
Does this project involve human participants and /or biological samples?
If YES, complete Annex E / Yes/No
Ethical approval
Does this work/the project on which this proposal is based require ethical approval (either NHS and/or Home Office)? / Yes/No
Has the work on which this proposal is based been submitted for ethical approval or considered to be covered by existing ethical approval? / Yes/No
If YES, by whom and when the ethics of the project were approved (include relevant reference number(s)).
If NO, by whom and when will the ethics of the project be considered.
Intellectual Property (IP)/Commercialisation
Will the proposed research use technology, materials or other invention that, as far as you are aware, are subject to any patents or other forms of intellectual property protection. If YES, give details. / Yes/No
Is the proposed research, in whole or part, subject to any agreements with commercial, academic or other organisation? If YES, give details. / Yes/No
Is there any potential for patents or commercially exploitable results from this research? If YES, give details. / Yes/No
If any potentially commercially exploitable results may be based upon tissues or samples derived from human participants, please confirm that there has been/will be appropriate informed consent for such use. / Yes/No
If this research is successful will it provide e.g. new tools, drugs, biological materials, methods of treatment etc. that add value to eye health through a product, drug, vaccine etc. that should be protected because it will make money for the owner?
If YES, please describe what this added value is.

Section 10: Applicant sign off

By signing this section, the principal applicant, confirms that he/she has complied with the instructions for completing and submitting this application and if the application is funded he/she will agree to the terms, conditions and processes of Moorfields Eye Charity.
Consultancies, equities and directorships
Do you have consultancies or any equity holdings in, or directorships of, companies or other organisations that might pose a conflict of interest to the current application? If YES, give details (max 100 words) / Yes/No
Applicant sign off details
Name [print]
Date [dd/mm/yyyy]
External peer review
Proposed external peer reviewers. Please provide the names and contact details (address and email address) for 4 potential external reviewers. These must not include colleagues from your organisation or those with whom you have published/collaborated with in the last 3 years
MEC may or may not choose to approach some, or all, of the individuals you have selected
Reviewer 1
Reviewer 2
Reviewer 3
Reviewer 4
Peer review restrictions. If you do not wish MEC to approach certain people or institutions, please provide the name/details below
Annexes and appendices: Please ensure that you complete and attach any necessary annexes and appendices with your final application. Tick all that apply
Grant application T&C [data use] from all individuals named in section 1
Annex A – Application budget [excel file]
Annex B – Research office sign off form/approval emails
Annex C – Collaborator forms
Annex D – Use of animals in research [Additional information]
Annex E –Clinical/translational research [Additional information]
Appendices: Letter of support(s) / Attached / To be email separately

Career development award application form Notes

[these notes pages can be deleted from the final version of the application submitted]

Note 1: Current supervisor/manager

Details of the current supervisor/manger should be included here and will be the person who provides a letter of support for the application. They should include how in the letter of support, details of howthey plan to support the applicant’s career during the funding period and beyond.