Expression of Interest: 2018 THRF Project Grant – TQEH/BHI
ContactInformation
ChiefInvestigator A (CIA)
Title:Firstname:Initial:Last name:
Position:
PhoneNumber:
E-mailAddress:
Organisation:
DepartmentorCentre:
Faculty:
Full Postal Address – work (including DX#):
AdministeringInstitution
Organisationname:
ABN:
ContactPerson:
PhoneNumber:
E-mailAddress:
PostalAddress:
Employment
How long have you been employed by this organisation?
When is your position’s renewal date?
Research Team
NOTE: Each Chief investigator should complete Attachment A.
ChiefInvestigator B (CIB)
Title:Firstname:Initial:Last name:
Position:
PhoneNumber:
E-mailAddress:
Organisation:
DepartmentorCentre:
Faculty:
ChiefInvestigator C (CIC)
Title:Firstname:Initial:Last name:
Position:
PhoneNumber:
E-mailAddress:
Organisation:
DepartmentorCentre:
Faculty:
Overview
NOTE: Grant Period: 1 July 2018 – 30 June 2019
Project Title:
Using lay terms, please detail the expected outcome of the research including who will benefit and why there is a need in the community. How is this project translating science to healthcare? (no more than 500 words)
Scientific overview of the project, including briefly describing the preliminary studies which validate the feasibility and delivery milestones of the proposed study (no more than 700 words)
Briefly describe the research plan. Detail your approach in a framework (no more than 1000 words)
Briefly outline the research teams experience in innovation and collaborations, including commercial collaborations and translating evidence into practice or public policy (no more than 300 words)
Milestones
Pleaseindicateyourkeymilestones that align with your research plan,alongwiththecompletiondateandassociatedcosts. Include any expected travel components. Please note, you will be expected to provide progress reports to THRF at the end of each milestone.THRF will provide awarded recipients with a template for this.
Milestone / CompletionDate / Cost $Confirmation of external funding support
If applicable, please provide a copy of any external funding support via copy of letter from third party funder when you submit your application to . You can also provide a letter of intent to provide leveraged funds with your EOI application.
Certifications and Approvals
Ethical Implications of the proposed research
Does this research involve any of the listed activities:
Experimentation on human subjects?Yes/NoProvide copy of the current approval.
Experimentation on animals?Yes/NoProvide copy of the current approval.
Use of GMO/GM productsYes/NoProvide copy of current OGTR approval
Copies of the above approval must be submitted with application to .
Signature of Chief Investigator(s)
I declare that the information supplied on this application, and any accompanying documentation to be true and correct.
If I/we am/are successful in obtaining a grant, the research will not commence until it has been approved by the relevant institutional committee/s.
Printed name of CIA:
Signature of CIA ______Date//201
(if relevant) Printed name of CIB:
Signature of CIB ______Date//201
(if relevant) Printed name of CIC:
Signature of CIC ______Date//201
Certification by the Director of Research, TQEH
I acknowledge that this EOI will be forwarded to the Director of Research, TQEH, Professor Guy Madden prior to the independent assessment panel to certify that the project is appropriate to the general research facilities of the BHI and/or TQEH.
(Please circle the below)
Yes / No
THRF TQEH/BHI Project Grant Application 20181