SYDNEY MEDICAL SCHOOL

CARDIOTHORACIC SURGERY RESEARCH GRANT SCHEME

APPLICATION FORM 2017

Applicants should send one (1) electronic copy of their application and one (1) hard copy, printed single-sided and including original signatures, to:

Manager

Sydney Medical School Foundation

Room 212

Edward Ford Building – A27

The University of Sydney NSW 2006

Email:

Project :

Title
Amount requested

Contact details of researcher:

Title / Family name
Given names
Present position
Full address
Telephone number / Work: / Mobile:
Email address

Application must include:

1. Research plan. An outline of no more than three (3) pages describing the proposed project including the following points:
ü  Title of the project
ü  Aims and significance
ü  Research plan, methods & techniques
ü  Budget outline
ü  Indication of the scientific journals to which publications will be submitted
2. Track record. Maximum one (1) page. This should include applicant’s academic qualifications, research experience and an explanation of why the applicant’s track record should be considered relative to opportunity if this is applicable.
3. Publications list 2005 +. Include here citation rates and impact factors of publications were possible.
4. A statement of no more than one (1) page outlining how this project will promote educational scholarship and research in cardiothoracic surgery or related fields and [will] … enhance the academic standing of participants, the dissemination of knowledge, and the international reputation of the Cardiothoracic Unit at Royal North Shore Hospital.”
All supporting documentation must be on single sided A4 pages in Arial 10 point font

Signatures

I certify I have read the guidelines relating to this scheme, that I accept the conditions of the scheme, and that all the information contained in this application is correct.
Applicant signature:
…………………………………………………………………………………………. Date: …………………
I certify that I am aware of this proposal and that if it is successful facilities are available in my Unit to conduct this research.
Head of Unit where research will take place:
……………………………………………………………………………………………. Date: ……………….
Head of Northern Clinical School signature:
…………………………………………………………………………………………… Date: ………………..

Privacy notice: The information supplied by you on this application is required by the Sydney Medical School in order to assess candidates for this funding scheme. The School reserves the right to reverse or vary any decision made if the School finds that the decision has been made on the basis of incomplete or incorrect information supplied by the applicant. The School may publicise the names, areas of research and other relevant details of successful applicants. Questions regarding access to, and correction of, any information should be addressed in the first instance to the Manager, Sydney Medical School Foundation.

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