Health Accelerator Award Application Form

1. Project Title

2. Project or Research Activity Summary

a)Please outline the research topic or research activity proposed(300 words max)

b)Please outline the strategic importance of the health research problem to be addressed and its strategic fit within the lead organisation (100 words max)

c)Please outline the potential long-term benefits of the collaboration and the likelihood of successful external funding (100 words max)

d)Please outline the strengths of the proposed collaborators in relation to the research project or activity proposed (100 words max)

3.Collaboration Details: Principal Investigator
Principal Investigator:
Contact Details: / T: E:
Host Institution for the Project
School/Division/Institute:
Project start date: / Project duration:
Collaborator Details: Co Investigators
Co-Investigator
Contact Details: / T: E:
School/Division/Institute:
Co-Investigator
Contact Details: / T: E:
School/Division/Institute:
Co-Investigator
Contact Details: / T: E:
School/Division/Institute:
Co-Investigator
Contact Details: / T: E:
School/Division/Institute:

Collaborator Details: Early Career Researcher Please identify which of the Co-Investigators qualifies as the project’s Early Career Researcher, and justify their eligibility and suitability for the project.

4. Details of the Collaborative PartnershipOverview of how the partnership will enhance health research across the two organisations. Demonstrating how the collaboration will draw on the specific strengths of the collaborators involved (250 words max.)

5. Justification for supportPlease state what resources will be required to deliver the project (max funding £10k)

6. Outline plan for future external funding

a)Please state the funding body and scheme where future funding will be sought

b)Please provide a timeline for submission, including the deadline for external applications

c)Please justify the choice in external funding scheme and eligibility of the research Collaborators

7. Project Budget

(i)Total Project Cost

Total Project Cost

(ii) Breakdown of resources requested

Salaries
Consumables
Equipment
Travel
Other (please specify)
Sub Total

8. Internal Approval Applicants must obtain a signature of approval from their Head of School/Institute/Division

Name
Signature / Date

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