*Expression of Interest Form*Form Template draft

i4i Connect Expression of Interest

Section: Introduction

Please note the following information and guidance is provided to applicants submitting an i4i Connect Expression of Interest (EoI) only.

There are a number of resources available to you throughout the online form to help guide you when submitting your EoI. It is advised that you take care to read thei4i Connect Expression of Interest Guidance available to download from the NIHR i4i webpageas well as the online guidance prompts(marked as a?) carefully whilst completing your application.

The deadline for submission is 1pm onWednesday 13September 2017

Applicants are expected, before submission, to have discussedthe content of their application with their own and any other body whose co-operation will be required in the conductof the research.

Research Details

Research title

Please provide the title for the project. This should be both concise and clearly descriptive and should contain keywords relevant to the project.

Lead SME (which will administer any award)

If your organisation does not appear on this list, please contact the Central Commissioning Facility

Please note that the project must be led by an SME. However, other organisations may be collaborators.
NOTE: If your organisation does not appear on this list, please contact the Central Commissioning Facility.

Project duration

Please indicate the expected length of the proposed projects in months.
NOTE: i4i Connectprojects can be a minimum of 6 months up to a maximum of 12 months in duration.

Proposed start date if awarded funding

(This must be between the dates of01/12/2017 and 01/01/2018)

Please indicate the proposed date on which the project would start.

Total Project Costs Requested

Please enter the FULL numeric value in £s only. i4i Connect will provide a maximum of £150,000 funding.
NOTE: You should avoid the use of shorthand, inclusion of commas or decimal places.

Section: Lead Applicant Details

Some of the responses required in this section will have been pre-populated based on your CV details andany remaining fields must be completed.

To update your CV details, please visit theManage My Detailssection by selecting 'Save and Close' at the top of this screen and accessing theleft handmenu toolbar.

TitleAddress

Forename

SurnameCity/Town

NationalityCountry

InstitutionPost Code

Phone number

Email

Section: Expression of interest

Please refer to the i4i ConnectGuidance located on the NIHR i4i website for further information.

Unmet Patient Need

(400 words max)

Proposed Solution:

(400 words max)

Benefit to Patients:

(400 words max)

Spending Plan:

(400 words max)

Applicant and Team Details:

(400 words max)

Company Information:

(400 words max)

Section: Validation Summary

Top of (online) page

Please follow the next steps in order to complete your application submission process;

●Validate all mandatory/required fields listed below (that are required to be completed/amended before submitting)

●Click 'Save and Close'

●Click the 'Submit' option (this must be completed by 1pm, 13 September 2017)

You will receive an automated email containing an acknowledgment that we have received your application.

Bottom of (online) page

If there are no validation requirements above you may be ready to submit the application. To do so 'Save and Close' the application.

Please note that yoursubmission will not be considered completeuntil all applicants have both confirmed and approved the applicationand the submit button becomes visible and is used.

Reference: i4i Connect– EoIDate received: 26July 2017

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