AREF Excell Programme 2018: Application Form Version: 14 December 2017

Please read the accompanying AREF Excell Programme 2018: Information for Applicants before entering information into this form. This Application Form has six Parts:

A: The Institution / B. Case for Support / C: Selection of Individual researchers
D: Supporting Documents / E. Other Information / F: Signatures

Complete this form electronically, using Font Arial 10. Write in the white spaces and not in green or other coloured spaces.

You will submit this Form with other documents, which are listed in Part D of the application form.

PART A: THE INSTITUTION

ABOUT THE INSTITUTION

  1. Official Name of Legal Entity (Institution)

Official name
Abbreviation used in the file name of submitted documents (Max 12 characters)

2. Official Address of legal identity

Please provide full details of your institution’s official work address i.e. details of your institutions official name, location (both city and country), and post code.

Details
Official physical Address
Website address
Address 2 (If any) Explain why this address should be used instead of the Official Working address.

3. Status of Legal Entity

Details
Please provide details of your organisation’s legal status by ticking the boxes to right end of the table. / Classification of legal entity (please select one)
(a) ☐ public or ☐ private
Mode of operation (please select one)
(b) ☐ not-for profit or ☐ for profit
Category (please select one)
☐ international organisation
☐ higher education establishment
☐ research organisation (not-for-profit)
☐ small or medium sized enterprise
☐ other (please specify)
Name of Legal Representative[1]
Email address of Legal Representative/Sponsor
Declaration / I declare that my institution is a legal entity established for purposes that include research and researcher training, based[2] in Sub-Saharan Africa
☐ Yes or ☐ No

4. Lead Applicant/Designated Academic Lead

Title (Professor, Dr)
Name of Lead Applicant
Position in the Institution
Contact Email address(s)[3]
Contact Phone number
Roles and responsibilities in Research Capacity Building
State your experience in academic development as evidenced through design, leadership and delivery of developmental training activities
Who do you report to and what is their position?

5. Application status

Are you applying jointly with another institution? ☐ Yes or ☐ No

If “Yes”, complete the following table below and provide a letter from the institution(s) which will state their role and contribution if any as co-applicants. The letter of support should be appended (see Part D, Table row 3).

Name of authorised Co-applicant / Job Title / Institution / Contact email / Role within Excell

INSTITUTIONAL ACHIEVEMENTS

6. Portfolio

List up to 5 of your top most recent live, competitively awarded (through “peer review”) health research/research capacity strengthening projects/programmes, funded nationally by government and internationally by donors and research funders

Name of Grant awarded / Year awarded and duration / Funder / Purpose of health Research/ Research Capacity Strengthening Grants / Financial value
(GBP)

PART B: CASE FOR SUPPORT

7. Summarise your institutional strategy for research and research capacity strengthening, including researcher and leadership development. A brief account of the policies and systems that are in place, or are being developed, of resources committed by the institution’s leadership, and examples of activities implemented. You must list and provide specific detail of the themes covered, funding amount and source, of any existing development programmes relevant to Excell. To reference relevant, significant publicly available information you may provide a URL; or you may add a document as a PDF (see Part D Table row 3). (Maximum 1200 words).

8. How would participating in the Excell Programme support your institutional research and research capacity strengthening strategy? How you might integrate the knowledge and skills developed through Excell within your own strategy, including how you could use up to 10,000 Euros of AREF support, and how you would measure success (outcomes and sustainability)? (Maximum 1500 words. Diagrams may be more easily submitted in a supplementary PDF: see Part D, Table Row 3).

PART C: SELECTION OF NOMINEES

9. Provide summary details of your nominees in the following table.

List your nominees in rank order from N1 (top) to N4 (Up to 4 nominees).

Given
Name / Last
Name / Gender
(M/F) / PhD
Qualification [4]
Date / Years of
post-doc
research
experience / Principal research discipline / Number & Value of
Top 3
grants won in £ / No of Publications
with Impact factor
≥4
N1
N2
N3
N4

10. Describe the process you went through in selecting your nominees? The criteria and process for nomination must be fair and transparent, designed to attract applications from strong performers (“rising stars”), and achieve gender balance and disciplinary diversity within the institutional cohort[5] (Maximum 500 words; you may attach a notice of your call for nominations, see Part D below, Table row 5).

PART D: SUPPORTING DOCUMENTS

The application form must be fully completed and be signed at Section F by your appropriate authorities. Save the document in the format <Institution_Ex18_AppForm.doc>, replacing “Institution by an identifier of your choice for your institution (up to 12 characters) and then convert it to PDF, which you should submit to AREF. The following documents must be submitted with your application form.

Evidence (as PDFs) / File name Substitute your institution’s identifier (max 12 letters) for “Institution” in the <file names> below”
  1. A letter from the Sponsor in support of the application. The letter should address the following:
 A brief statement of the institution’s capabilities in global health research and research management
 How the Sponsor is directly involved in research capacity building and, in particular, researcher and leadership capacity development (academic development)
 How the Sponsor will integrate the Excell programme into the institution’s research capacity development strategy
 The potential to work with other institutions, such as national and regional capacity development networks, to enhance researcher and leadership development. / <Institution_Ex18_Sponsor.PDF>
  1. The short academic CV of the Lead Applicant (and any co-applicants).
/ <Institution_Ex18_LeadCV.PDF>
  1. Selected documents as appendices to supplement the account in the application form, organogram, strategy document, data; and letter of support if jointly applying with another organisation see (Part A, Section 5): List them here:
S1:
S2:
S3:
S4: / <Institution_Ex18_AppS1.PDF>
<Institution_Ex18_AppS2.PDF>
<Institution_Ex18_AppS3.PDF>
<Institution_Ex18_AppS4.PDF>
  1. The portfolio of nominees’ information, comprising the following (a) The application forms and short CVs of up to four nominated researchers; (b) Nominees’ supplementary evidence: Best two publications (if not easily accessible on the web), their PhD certificate (or equivalent). No more than three of these PDFs per nominee.
N1AFNominee 1, application form
N1CVNominee 1, short academic CV
N1SENominee 1, supplementary evidence
And so on for nominees 2, 3 and 4. / <Institution_Ex18_N1AF.PDF>
<Institution_Ex18_N1CV.PDF>
<Institution_Ex18_N1SE.PDF>
and so on for nominees 2, 3 and 4.
  1. Evidence supporting your account in the application form of your institution’s selection process for nominating researchers to participate, e.g. PDF of an internal call.
A1. Name of appendix
A2. Name of appendix
A3. Name of appendix / <Institution_Ex18_SelectA1.PDF>
<Institution_Ex18_SelectA2.PDF>
<Institution_Ex18_SelectA3.PDF>

PART E: OTHER INFORMATION

Please tick ONE or more boxes to indicate how you heard about this programme or indicate which national newspaper, job vacancy website, research network etc.

AREF advertisement / ☐ / Regional Networks (Which?) / ☐
Your nominee / ☐ / From a professional colleague / ☐
Global Health Network website / ☐ / If other, please state below / ☐

PART F: SIGNATURES

  1. Signature of Lead Applicant/Designated Academic Lead

NAME OF LEAD APPLICANT/DESIGNATED ACADEMIC LEAD
YOUR SIGNATURE
JOB TITLE & ORGANISATION
DATE
  1. Institutional Sponsor[6]

ATTESTATION / By signing this application, I declare I am a named official of my institution’s leadership and I have the legal authorisation to sign off on this application.
NAME OF SPONSOR
JOB TITLE & ORGANISATION
YOUR SIGNATURE
DATE
SUBMISSION: The application form and accompanying documentation should be submitted as individual files to Mr Sulayman Janneh, AREF Awards and Finance Manager by email to (copy ) so as to reach AREF by the published deadline of 16.00 hours GMT on 15 March 2018. Applications received after the deadline will not be considered.
Your application will be INELIGIBLE if the Form is not completed properly or if the accompanying documents are not complete, or if they are received after the published deadline for receipt of applications.

END OF AREF APPLICATION FORM

AREF Excell Programme 2018_Application Formpage 1 of 8

[1] A legal representative is a natural person who has been empowered (directly or indirectly) by a legal entity to enter into legal commitments on its behalf

[2] “based in” means that the leadership, governance and programmes of the institution are based unequivocally within the region (a field-site directed by the institution is not eligible). However, an internationally recognised institution that can evidence funding, staffing, governance and outputs that show it has connections and impact outside the country in which it is legally established is eligible to apply. Refer to section 2.1 of the Information for Applicants guidance.

[3] Your contact details will be used to contact you about your application and for the purposes specified in our privacy statement:

[4] Refer to section 2.2 of the “Information for Applicants” for eligibility criteria for research clinicians

[5] Refer to section 5.3.2 of the “Information for Applicants” for further details

[6] A named official with the responsibility for research capacity development, such as the pro-vice chancellor for research or the research institution’s director