Only typed applications will be accepted

SECTION A: Applicant details

1.  Lead applicant/Chief investigator

Applicant title:
Applicant forename:
Applicant surname:
Profession:
Degrees / Qualifications:
Post held:
Postal address:
Email address:
Contact Telephone:
Location where research will be conducted:

2.  Co-applicants details (if relevant)

Please state the number of co-applicants:

Please include the following information for each co-applicant:

·  Please copy and paste a new table for each co-applicant

Title/first name/surname:
Profession:
Email and telephone:
Statement of their role in the research:

SECTION B: Research details

·  Must be written in lay language for a patient population to understand.

Full title of project:
Aims of project:
No more than 200 words.
What are you hoping to achieve.
If relevant what are the primary and secondary aims?
Background to project:
No more than 200 words.
·  What is the history of research in this area?
·  How does this study follow / support previous research in this field?
·  Do you or members of your team have any experience of research in this area?
Value of this project:
No more than 200 words.
·  How would this study contribute further knowledge?
·  What is the potential benefit to patients?
·  What other developments might this research lead to?
·  Other relevant information.
Has funding for this project been sought / granted / refused elsewhere?
Please give details and explain how this award would allow further funding to be obtained.
Research plan and methodology
Please include: study design; justification of sample size; power calculation; inclusion/exclusion criteria; methods of allocation; outcome measures; methods of data collection; methods of analysis; time scale; location; ethics requirements; local R&D requirements; any public involvement in design; peer/external review; plans for dissemination.
·  Must be written in lay language for a patient population to understand
·  Must not exceed 2 A4 pages

SECTION C: Finance details

BESS research grants are awarded for appropriate projects to a value up to £3000.00

Please state total amount required / £
Please detail and justify how you will spend the grant.
You should include details and cost of recurring expenses (e.g. imaging investigations/blood tests) and non-recurring expenses (e.g. software).

Recurring expenses

Please detail, justify and state amount for each recurring expense:
Total recurring expenses / £

Non-recurring expenses

Please detail, justify and state amount for each non-recurring expense:
Tota Total non-recurring expenses: / £
Total of recurring and non-recurring expenses:
£

SECTION D:

The lead applicant/chief investigator and co-applicants, confirm that:

1.  To the best of their knowledge, the information contained in this application is correct and accurate.

2.  No individual applicant has a conflict of interest associated with this research project.

3.  No research will be conducted that requires ethical and R&D approval before that approval is granted in writing.

4.  It is understood being awarded a BESS research award does not replace the requirement for ethical and R&D approval.

5.  All applicants agree that if granted a BESS research award that the award will be acknowledged in all publications and/or oral or poster presentations associated with the research that the award supported.

6.  All applicants agree that the work will be submitted for presentation at an appropriate BESS meeting, as far as possible within two years of the award being granted.

Signatures

Lead applicant: (name in capitals, signature and date)
Co- applicant: (name in capitals, signature and date)

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