Application Form
NC3Rs Public Engagement Small Awards
Please complete this form and submit it to . Further guidance and eligibility criteria can be found at
Please complete sections 1-5.
1.Contact details:
a)Title:b)First name:
c)Surname:
d)Job title:
e)Email address:
f)Telephone number:
g)Institution:
h)Institution address:
i)Grant holder name*
*Name of Principal Investigator/Co-Investigator on NC3Rs grant, or contractor on CRACK IT contract.
2.Public engagement and outreach experience:
a)Please list any previous events and activities you have taken part in which have been targeted to a public audience, particularly those explaining the 3Rs.3.Public engagement during your NC3Rs grant(s) or award(s):
b)Please list any previous events and activities you have taken part in which have been targeted to a public audience, particularly those explaining the 3Rs.4.Proposed activity details:
a)Activity title:b)Activity summary:
Max 250 word summary outlining objectives, audience, activity type and the science covered.
c)General aims and objectives:
Please include learning objectives for the audience, and pay particular attention to the 3Rs aspects of your proposed activity.
d)Target audience:
Who you are intending to target. Please include estimated age groups and numbers.
e)What area of science and the 3Rs will your project cover and how do you intend to communicate it so it is accessible to your target audience?
f)How will you promote your activity to ensure it reaches your target audience?
Please include channels and methods.
g)Expected outcomes for the researchers (you!):
h)How will you know if your project has been successful?
Please include details of any evaluation you intend to do.
i)Please provide details of any other partners you intend to work with on the project:
For example, does this project form part of a local event (e.g. a science festival or a café scientifique)/are you giving a talk to a ready formed community group (e.g. Scout group).
5.Award details:
a)What is the total cost of this project?b)How much are you requesting from the NC3Rs?
c)Is your activity free for participants or is there an admission fee?
d)Please list any other contributions you have to support the project
Either in-kind (volunteers) or in the form of sponsorship (funding from your institution).
5. Please provide a breakdown of the budget for this project:
Submit as a separate attachment if needed.
Item and description: / Cost: / Covered by:e.g. String / e.g. £5.00 / e.g. NC3Rs grant/other grant
Total cost of project:
Total requested from NC3Rs:
In accordance with the Data Protection Act 1998, the personal data on this form will be processed by the NC3Rs and may be held on computerised database and/or manual files.