College of Paramedics: Small Grants Scheme

College of Paramedics: Small Grants Scheme

Closing Date Thursday1stFebruary 2018 at 17.00

Application Form

Q1.Principal Applicant’s details

Surname
Forenames
Title
Position
Organisation
Email address
COP Membership No

Q2.Title of project:

Q3. Period for which support is sought:(state in months)

Q4. Proposed startdate (not before 5th March 2018

Q5. Total amount of support requested:

Q6. Summary of proposed activity(no more than 400 words)

Q7. RELATEDAPPLICATIONS

Is thisor a related application currentlybeing submitted elsewhere?YES/NO

Ifyes,pleasenametheorganisation(s)and provide the date(s) a decision is expected:

Q8. DETAILSOF PROPOSED ACTIVITY(no more than 1500 words)

Pleasedetailthefollowinginformation:

(a)researchquestion(s)to beaddressed

(b)aimsoftheproject

(c) expected outcomes, with specific refence to the value to NHs and healthcare in general

(d)workwhichhasleduptotheproject,

(e)planofresearchand methodologytobeused including information on proposed sample, setting, proposed approach to data collection and analysis

(f) relevanceoftheprojecttopolicyandpractice

(g)brief timetableand milestones

(h)yourstrategyforsharing and disseminating the results/findings

(i) any ethical considerations.

Q9. DETAILSOF FINANCIALSUPPORTREQUESTED(Please provide fulldetails.)

Description / Total Cost

Brief justification of costs:

Q10. RESEARCHINVOLVINGHUMANPARTICIPANTS,BIOLOGICALSAMPLESANDPERSONALDATARELATING TO LIVING ORDEAD PERSONS

Doesyourprojectinvolve human participants? YES/NO

Will personal data be used?YES/NO

Will yourprojectinvolve useof biological samples?YES/NO

Please state bywhomandwhentheethicsoftheprojectwillbereviewed,andspecifyanyother regulatory approvals that will be sought.

In the courseof yourproject:

(i) Doyou propose to usefacilitieswithin the National Health Service (NHS)?YES/NO

(ii) Doesyourresearchinvolve patients being cared forby the NHS?YES/NO

Ifthe answer isyesto(i)or(ii)above, pleaseindicate whichorganisationhasagreedto bethe sponsorfortheprojectundertheResearchGovernanceFrameworkforHealthandSocialCare,publishedby theDepartmentofHealthinEnglandorthe corresponding departmentsinNorthernIreland,Scotland orWales.

Q11. CURRICULUM VITAE OF LEADAPPLICANT:

Surname:

Forename:

Title of current post:

Date of appointment:

Current employer:

Previous posts held:(listthe mostrecent first):

Date from / Date to / Position / Department / Organisation

Education/training:

Date from / Date to / Organisation / Qualification / Grade

Publications

Pleaselistonlyyouroriginalresearchpublicationsandotherscholarlycontributionsthatyouconsiderto be significant.Publicationsshould be in chronological orderwiththe mostrecent first.

Q12. CO-RESEARCHERS (Please fill in this section for each additional individual)

Collaborators,whoareassociatedwiththisresearchproposal,are asked to complete the following:

Name:

Current employment:

Are you a member of the College of Paramedics?YES/NO

If YES, please state Membership Number

Extent and nature of collaboration: Detailtheroleandcontributionofthe collaborator,withanindicationofthe timethepersonwillspendonthe project(no more than 200 words).

Q.13 Signature:

I confirm that to the best of my knowledge the details in my application form are accurate.

Signature of Lead Applicant:

Date:

Please return your completed form to:

by 17.00 on February 1st 2018.

Small Grants Research Application Form 20181