FULL APPLICATION FORM /
The completed forms should be returned by email to by 5pm onThursday 12November 2015. The original signed form (including supporting original documents and signature page) and an additional 3 unbound single-sided copies must be postmarked by the deadline date and sent to the Grants Officer, Fight for Sight, 1st Floor, 18 Mansell Street, London E1 8AA. Applicationsemailedand/or sent after the deadline will not be considered. Please mark the outer envelope with the sender’s details. Applications not abiding by the guidelines will be rejected.
1. SUPERVISOR
Title:Surname:Forename(s):
Post(s) currently held:
Address:
Telephone work:Mobile:Email:
SECOND SUPERVISOR (please refer to guidelines)
Title:Surname:Forename(s):
Post(s) currently held:
Address:
Email:
2. COLLABORATORS(please refer to guidelines)
a.
b.
3. TITLE OF PROJECT(as per abstract application)
Proposed Start Date:Duration (months):36 months
4. RESEARCH PRIORITY AREA
Please indicate the research priority area your application is considered under (as per abstract application)
5. SIGHT LOSS AND VISION PSP CATEGORY AND PRIORITY
Please indicate the category and priority your application addresses(as per abstract application)
6. SCIENTIFIC ABSTRACT OF RESEARCH PROJECT (maximum 250 words)
7. DESCRIPTION OF RESEARCH FOR LAY PEOPLE(maximum one side of A4)
Describe the research proposal under the given headings. The lay summary will be used to inform the lay attendees at the Grants Assessment Panel meeting and the Grants Committee who makes the final funding decision (please refer to guidelines).
- Brief background and need for the research
- Aim of the study
- Method of investigation
- Information the research will provide. Explain how achieving your research objectives will benefit patients, either as a direct result of your findings, or to inform future research that may result in clinical benefit.
8. CLINICAL BENEFIT
Briefly describe the steps and timeframe anticipated for delivery of benefitsfor patients after the end of this research project (maximum 250 words).
9. OTHER SUPPORT
Has this or a similar application been submitted to another funding body in the past year? If so, which body and what was the outcome?
Is this application being, or likely to be, submitted elsewhere? If so, to which organisation and when is the outcome expected?
Does this application relate to any other grant funded by Fight for Sight or any other application to Fight for Sight?(please refer to guidelines)
Has the supervisor been funded by Fight for Sight in the past and if so what was the outcome of the funded research?(please refer to guidelines)
10. USE OF ANIMALS
Does the project involve the use of animals?
How have you considered the 3Rs (Replacement, Reduction and Refinement)? (maximum 100 words)
Are the necessary Home Office project and personal licences in place? Please include PPL and PIL reference numbers. (please refer to guidelines)
11. RESEARCH ETHICS COMMITTEE APPROVAL
Does the project involve human participants (including human data, human tissue or human samples) requiring research ethics committee approval?
If so, please provide details of the Research Ethics Committee (REC) to which an application has been submitted and the date of approval or the date when a decision is expected.(please refer to guidelines).
If approval is already in place please include reference number(s) and attach copy(ies) of the letter(s) of approval.
12. PROPOSED RESEARCH (please note word and space restrictions, applications ignoring them will be rejected)
a. The research question (maximum 100 words)
b. Importance of research (maximum 250 words)
c. What are the expected outcomes of the research and how will they be evaluated? (maximum 250 words)
d. Description of the proposed research (maximum3 sides of A4, please refer to guidelines)
- Aims of the research
- Background (work that has led up to the project)
- Plan of investigation, methods and techniques
- Timetable and milestones
e. References (Relevant to the project.No more than one side of A4. Please refer to guidelines.)
13. SUMMARY OF SUPPORT REQUESTED (please refer to guidelines)
Year 1£ / Year 2
£ / Year 3
£ / Total
£
Stipend
PhD Fees
Total student costsConsumables expenses
Animal expenses
Other expenses (including travel)
Total recurrent expenditure
Equipment expenses
Total support requested
- London Weighting to be included, if applicable.
14. DETAILS OF SUPPORT REQUESTED
Year 1£ / Year 2
£ / Year 3
£ / Total
£
Consumables (please list)
Equipment
Animal expenses
(purchase and maintenance)
Other expenses
(e.g. Travel)
Total
JUSTIFICATION FOR SUPPORT DETAILED ABOVE (maximum half a side of A4)
15. BACKGROUND INFORMATION
Please describe the Department/Institution’s previous experience in vision research, special features and facilities of the research training environment, relevant collaborative projects and basic research resources available (maximum half a side of A4).
16. TRAINING
Description of the training programme for the PhD student, to include: mechanisms for monitoring progress(interim reports, PhD committee meeting), availability of taught courses (writing, basic statistics, etc), oral and poster presentation skills practice, etc. (maximum half aside of A4).
17. CURRICULUM VITAE OF SUPERVISOR(maximum 2 sides of A4)
Title:Surname:Forename(s):
Post(s) currently held:
Date of Appointment(s):Expected date of Termination(s):
With whom do you have your current contract of employment?
Academic and Higher Qualifications:(subject, class, university, date, most recent first)
Previous three posts held:(with dates, most recent first)
Current PhD students:Please indicate number of PhD/MD students currently being supervised including dates and funding bodies.
Previous PhD students:Please state number of previous PhD/MD students supervised (including those who did not complete) and how many completed including dates and funding bodies.
Recent publications:Maximum 10, relevant to the project, in chronological order, the most recent first. Please give citations in full (please refer to guidelines).
Grant support:Please list grants held in the past five years, most recent first including the title of project, amount awarded, duration of grant and funding body. For current grants, indicate the number of hours per week that are spent on each project.
18. CURRICULUM VITAE OF SECOND SUPERVISOR(maximum 2 sides of A4)
Title:Surname:Forename(s):
Post(s) currently held:
Date of Appointment(s):Expected date of Termination(s):
With whom do you have your current contract of employment?
Academic and Higher Qualifications: (subject, class, university, date, most recent first)
Previous three posts held: (with dates, most recent first)
Current PhD students:Please indicate number of PhD/MD students currently being supervised including their funding bodies.
Previous PhD students: Please state number of previous PhD/MD students supervised (including those who did not complete) and how many completed including dates including funding bodies.
Recent publications:Maximum 10, relevant to the project, in chronological order, the most recent first. Please give citations in full (please refer to guidelines).
Grant support: Please list grants held in the past five years, most recent first including the title of project, amount awarded, duration of grant and funding body. For current grants, indicate the number of hours per week that are spent on each project.
19. SUPPORTING DOCUMENTS
Please attachthe signed original letter(s) from all collaborator(s) stating their willingness to participate in the proposed research.
20. SIGNATURES
The application must be signed by the supervisor and submitted with the approval of the Head of Department and the Finance Officerwho will be responsible for the administration of the grant.
SUPERVISOR
I have read Fight for Sight’sTerms and Conditionsand agree to abide by them. I will be responsible for the day-to-day supervision of the research. My contract in the Host Institution lasts at least as long as the duration of the award.
Signature:
Date:
Note: Fight for Sight’s Terms and Conditions have been revised.
HEAD OF DEPARTMENT
I have read this application and confirm that, if successful, the project will be accommodated and administered in the Department/Institution and the infrastructure and support will be provided as described.I have read Fight for Sight’s Terms and Conditionsand confirm that they are acceptable.
Signature:
Date:
Note: Fight for Sight’s Terms and Conditions have been revised.
FINANCE OFFICER
I confirm that the Host Institution will administer the grant if awarded. I have read Fight for Sight’s Terms and Conditionsand confirm that they are acceptable. The funds will be used only for the purpose for which they are given.
Signature:
Date:
Note: Fight for Sight’s Terms and Conditions have been revised.
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