Research and Development Grants Program
RESEARCH PROJECT GRANT
APPLICATION FORM
  1. Name of Grant

Name of grant for which you are applying

  1. Chief Investigator
  1. Project Title

Please provide a title that is clear, precise and informative to workers outside your field

  1. Project Synopsis

Present a short succinct summary outlining your proposed project. The synopsis should explain the purpose of the project and describe what the project will do.

SHPA Research Project Grant Application Form – May 2008 / 1
  1. Investigating Team

Please provide a brief CV as outlined below for each of the investigators. The Chief Investigator is responsible for the management of the project and will be regarded as the contact person.

Chief Investigator:

Name:

Address:

Telephone:

Facsimile:

Email:

Current Employment:

Summary of Previous Employment (brief outline of positions held):

Academic Qualifications:

Area of Expertise:

Membership of Professional Societies / Groups:

Length of current SHPA Membership:

Membership of Professional Committees:

Previous SHPA Grants (include name of grant, purpose, grant amount, date granted):

Other Research Grants:

Prizes and Awards:

Publications (limit to five most recent publications):

Co-Investigator 1:

Name:

Address:

Telephone:

Facsimile:

Email:

Previous SHPA Grants (include name of grant, purpose, grant amount, date granted):

Other ResearchGrants:

Prizes and Awards:

Publications (limit to five most recent publications):

Co-Investigator 2:

Name:

Address:

Telephone:

Facsimile:

Email:

Previous SHPA Grants (include name of grant, purpose, grant amount, date granted):

Other Research Grants:

Prizes and Awards:

Publications (limit to five most recent publications):

  1. Project Details

A maximum of five pages should be used

6.1Aims and Objectives

Clearly define the objectives of the project

6.2Hypotheses

6.3Background (with references)

Provide a rationale for the project and detail research already done on the topic

6.4Methodology

Provide details of project design, group / population to be researched or sampled, evaluation methodology, statistical analysis.

6.5Timetable

Include likely start and finish dates as well as project timetable.

6.6Expected Outcomes

Describe the outcomes you expect to be available at the end of the project.

6.7Dissemination

Describe how the results / project outcomes will be disseminated.

SHPA Research Project Grant Application FormJune 2015 / 1
  1. Proposed Grant Budget

Applicants must provide a detailed project budget. This pro-forma is to be used as a guide for completing a budget for the overall project. PLEASE NOTE: Not all items will be applicable for funding; these are examples only.

Name:
Project Title
Registration / Course Fees / $
Accommodation Expenses / $
Travel Expenses (e.g. air, taxis, bus, train) / $
Salaries (e.g. Project Officer; Locum/Backfill Costs – for preceptorships in particular) / $
Project Management Resource Details and Associated Costs (e.g. salaries or charges for technical assistance for statistical analysis or IT support) / $
Materials/Consumables/Equipment Expenses (e.g. books/study material; assay equipment; computer hardware or software) / $
Other/Miscellaneous Expenses (e.g. ethics fees; stationery; photocopying; printing of leaflets/brochures/posters) / $

Other

/ $

Other

/ $
Total Funds Requested / $
SHPA Research Project Grant Application FormJune 2015 / 1
  1. Declaration of other Financial Support

To facilitate coordination with other funding bodies, and to optimise use of available funds, applicants are asked to advise if funding has been, or is being, sought from other sources.

Have you obtained other financial support for this research project? Yes No

Tick relevant box :

If yes, other source(s) / $

If no, are you applying for other support:Yes No

Tick relevant box :

If yes, give details

Please note: if additional funds are obtained from other sources after this application has been considered, applicants must immediately inform SHPA. Failure to disclose full information may result in an application being rejected.

  1. Leave Considerations

YesNo

Is absence from your employment necessary?Tick relevant box :

YesNo

If yes, has leave been approved?Tick relevant box :

  1. Referees

Title: / Title
Name: / Name:
Address: / Address:
Phone: / Phone:
Facsimile: / Facsimile:
Email: / Email:
Area of expertise: / Area of expertise:

Applicants should note that Referee Report Forms are to be returned no later than the closing date of the grant.

You will need to provide referees with a copy of your application and sufficient information so they may assess the grant.

It is the applicant’s responsibility to forward the Referee Report Form to their nominated referees to complete and request that the form be returned directly to:

Research and Development Grants Advisory Committee

The Society of Hospital Pharmacists of Australia

Phone: 03) 9486 0177

  1. Statement of Head of Department

I support the application:

Name:
Position:
Signature: / Date:
  1. Certification by Applicant

In signing this page, I certify that all details in this application are correct and that I agree to abide by the Society of Hospital Pharmacists of Australia Mandatory Conditions for grants.

I understand and agree that if my application for a grant is successful the grant will be made on condition that I will do everything reasonably within my power to ensure that the funding granted by the Society of Hospital Pharmacists of Australia is acknowledged in any:

  • Publication
  • Announcement to the public for the medical or scientific community
  • Statement to the media
  • Lecture or seminar relating to the project (whether or not it also relates to other matters).

I also understand/agree that I shall submit a final report in the required format and any progress reports as may be requested to the Research and Developments Grants Advisory Committee.

I declare that I do not have reports outstanding relating to grants awarded by the SHPA Research and Developments Grants Advisory Committee.

I agree if successful in obtaining grant funding that my name, workplace and state may be mentioned in news bulletins associated with the grant/award.

Signature / Date
Signature / Date
Signature / Date
  1. Ethical Implications

Research projects involving patients and patient data will require institutional ethics committee approval before funds are released.

CHECKLIST

Have you included:

  • Your completed application form including supporting documentation
  • Cover letter as part of the application process (where applicable)

Have you forwarded:

  • Referee Report Forms to two referees for completion

You must submit your entire application including all supporting documentation and two referee reports.

SHPA will email confirmation of receiving your application within 2 weeks. If you have not received an email after this time please call our office.

Email completed applications by the closing date of the grant to:

Ensure email and attachments do not exceed 10 MB. If larger send applications and referee reports separately to ensure all documents are received.

Research and Development Grants Advisory Committee

The Society of Hospital Pharmacists of Australia

Phone: 03) 9486 0177

APPLICATIONS MUST COMPLY WITH ALL GRANT CONDITIONS OR THEY WILL BE RETURNED TO THE APPLICANT WITHOUT REVIEW
SHPA Research Project Grant Application FormJune 2015 / 1
RESEARCH AND DEVELOPMENT GRANTS PROGRAM
RESEARCH PROJECT GRANT
REFEREE REPORT FORM
(PLEASE TYPE DETAILS )
REFEREE’S NAME:
ORGANISATION:
POSITION:
AREA OF EXPERTISE:
EMAIL ADDRESS:
APPLICANT’S NAME:
PROJECT TITLE:
NAME OF GRANT:

Please give brief details of your assessment of the applicant’s proposed research project with regard to the following:-

  1. APPROPRIATENESS OF METHODOLOGY

e.g. Does the methodology match the hypothesis/objectives, are the results likely to be accurate, are the statistical methods proposed appropriate etc.

  1. RELEVANCE

Please comment on the relevance of the proposal to the advancement of hospital pharmacy or health care.

  1. SIGNIFICANCE & ORIGINALITY

How would you rate the significance and originality of the proposal?

  1. COMPLETION

Is the proposal likely to be completed as outlined (with reference to time frame, budget) Comment on ability of applicant to complete the project.

  1. LIMITATIONS

Do you consider their are any limitations to the project? Are their any issues of relevance not identified?

If so please outline.

  1. OTHER COMMENTS

Any other pertinent comments that will assist the committee reach a decision. (Include here areas where the application could be improved).

7.RATING

How would you rate this application? (please tick appropriate box)

Poor / Satisfactory / Good / Very good / Excellent

8.FUNDING RECOMMENDATIONS

(please tick appropriate box)

Full funding

Partial Funding(indicate amount)
$ ______

No Funding

Referee’s Signature: ______Date:______

Note: Please complete and return by the grant closing date to:

Research and Development Grants Advisory Committee
The Society of Hospital Pharmacists of Australia
Phone: 03) 9486 0177

SHPA Research Project Grant Application FormJune 2015 / 1