Principal Investigator

Name, position and contact details (email and telephone number) of lead applicant:
University department:

Co-Applicants

Name, position, University department and Division of all co-applicants:

Project details

Title:
Start date:
End date:

Research area (please tick all that apply)

Vaccine science
Inflammation
Cancer
Diabetes
Dementia/psychiatry
Rare diseases
Physical sciences linked to medical research
Other (please describe)

Funding details

Total direct cost of the research project:
Source of match funding e.g. UCSF, industry, departmental match:
Value of match funding:
Amount requested from the MRC Confidence in Concept Fund:

Breakdown of costs requested from the MRC Confidence in Concept Fund

Purpose / MRC CiC Contribution / Oxford University match contribution
Post 1
Post 2
Equipment
Consumables
Other (please specify)
Total

Ethical review status

Does the project require ethical review?
Yes If you have a CUREC number approved for this project please provide it here: ______
If not, you must obtain a number before the project can start
No
Does the project involve use of animals and therefore require personal and project licences?
Yes No Approved
If required: appropriate personal and project licences for the project must have been approved before the project can start.

Endorsement by head of host department

Name
Signature / I accept the responsibility for matching funding (50% of direct costs) being secured.

Administrative contact for MRC CiC award

Name, position and contact details of administrative contact:

Please append the following to your application:

·  Two page summary of the research project for which MRC Confidence in Concept funding is being sought

·  A one page CV for each applicant named in this application form

·  An X5 costing admin output for your project, this does not need to be submitted to Research Services

The two page summary should be organised under the following headings:

·  Lay summary (no more than half a page)

·  Research objectives and proposed outcomes (including information about proposed development milestones and potential next steps following completion of the project e.g. sources of follow on funding, plans for commercialisation)

·  Research project timeline

·  Justification for support

·  Industry engagement