Collaborative Cancer Grant Scheme

for early to mid-career investigators (CCGS)

for projects commencing in 2018/2019

EXPRESSION OF INTENT FORM

Once complete, please save this form in either Word or pdf format and email to

Forms must be received by: 4pm, Monday19 March 2018

This expression of intent will be assessed by the academic members of the assessment panel. When answering this section, remember that while the assessors are all cancer researchers, they may not have specific expertise in your area of research.

  1. CONTACT INFORMATION

Mailing Address
Title
Address 1
Address 2
Address 3
Suburb / Postcode
Chief Investigator A – contact details
Name / email
Telephone / Mobile
Responsible Officer at the Administering Institution
Name / email
Telephone / Mobile
  1. PLAIN LANGUAGE TITLE

  1. TEAM

CIA (name, include title):
Qualifications, including award date/s (attach early-mid career qualifying documents, as per the guidelines to applicants)
Primary Research Position, (include organisation details)
Other positions include adjunct and co-appointments etc (include organisational details)
**NB % Research Time refers to the percentage of research time to be allocated to the CCGS Project
CIB (name, include title):
Qualifications, including award date/s (attach early-mid career qualifying documents, as per the guidelines to applicants)
Primary Research Position, (include organisation details)
Other positions include adjunct and co-appointments etc (include organisational details)
**NB % Research Time refers to the percentage of research time to be allocated to the CCGS Project
CIC (name, include title):
Qualifications, including award date/s (attach early-mid career qualifying documents, as per the guidelines to applicants)
Primary Research Position, (include organisation details)
Other positions include adjunct and co-appointments etc (include organisational details)
**NB % Research Time refers to the percentage of research time to be allocated to the CCGS Project
CID (name, include title):
Qualifications, including award date/s (attach early-mid career qualifying documents, as per the guidelines to applicants)
Primary Research Position, (include organisation details)
Other positions include adjunct and co-appointments etc (include organisational details)
**NB % Research Time refers to the percentage of research time to be allocated to the CCGS Project

NB: add tables as required

  1. COLLABORATION

Briefly outline:
-how the Collaboration is new, why is it important and what makes it different from your current collaborations
Limit: 800 characters (including spaces and line breaks)
  1. BACKGROUND AND RESEARCH PLAN

Include, significance to cancer, hypothesis, methods and timeline
Limit: 1,200 characters (including spaces and line breaks)
  1. SIGNIFICANCE AND INNOVATION

Briefly outline:
-why this research is important
-how this researchis new / different from your current research (Blue sky projects are encouraged ie curiosity-driven, exploratory, and innovative)
Limit: 600 characters (including spaces and line breaks)
  1. COMMUNITY INVOLVEMENT

Briefly outline:
-Outline how community representatives (consumers) have been involved in the development of the EOI
Limit: 200 characters (including spaces and line breaks)

INSTRUCTIONS

APPLICATIONS CLOSE: 4pm,Monday 19 March 2018

To be emailed to

1 x electronic version, plus the relevant qualification documentation (word format preferred)

CCGS Expression of Intent Application form 2018Page 1