Guy's and St Thomas' Charity Hospitals Cancer Fund

Request for funding

Deadline for application could be found on our website,

Full guidelines appear at the end of this form. For more information or assistance completing this application please

Section A: Applicant details

Primary applicant

Title / First name / Surname
Position
Department
Address
Email / Telephone

Co-applicant (if applicable)

Title / First name / Surname
Position
Department
Address
Email / Telephone

Grant holding organization

GSTT KCL*

* KCL applications must go through the appropriate internal procedures before being submitted, please contact at the KCL Research Grants and Contract team for more information.

Section B: Project details

1. Project name (less than 10 words)

2. Project type

Equipment Training Research Other(please specify)

3. Amount requested

Full amount requested in GBP

4. Project description

Describe this proposal, setting out clear objectives. This will be used to assess the application and measure the success of this project if funded.

5. Describe benefits to patient care

Specify the direct benefits to patient care arising from this proposal.

6. What is the incidence of the condition(s) concerned? Please specify the annual number of patients affected at GSTT

7. How will you demonstrate the success of this project?

Clearly list all expected outcomes and how you will measure them

8. Does your department have a local user group? Yes No

If yes, does the local user group support this application? Yes No

If yes, please describe the steps you have taken toinvolve the local user group in the development of this application and summarise any feedback you have received from them. If no user group exists, please describe how you intend to obtain user feedback on this proposal.

9. Non-confidential summary

A brief summary of the proposal, this is used to describe successful projects on our website and maybe used for fundraising purposes.

Section C: Urgency of need

10. Please indicate the urgency of your application

This project should be considered for normal funding
This project should be considered for urgent funding

11. If urgent, please describe the need for urgent funding.

Section D: Budget

12. Budget requested (Continue on a separate sheet if necessary)

Equipment *
Medical, laboratory or IT equipment – please itemise and exclude VAT**
1
2
3
4
5
Total / £
Staffing costs
Please include a costing sheet signed by the appropriate finance manager
1
2
3
4
5
Total / £
Other *
(includes training costs)– please itemise
1
2
3
4
5
Total / £
Total requested / £

* Please enclose quotes for any items, if successful these must be ordered via Trust/KCL Procurement

** Certain medical, scientific, computer, video, sterilising, laboratory and refrigeration equipment is 0% rated for VAT providedit is used for medical research, training, diagnosis or treatment. Please contact your finance team for more information

13.Please describe any alternative sources of funding and steps taken to access them

Section E. Signatures

14. Signature of applicants*

Primary Applicant / Date
Secondary Applicant / Date

15. Signature of Head of Service*

Name
Title
Signature / Date

16. Finance authorisation (for KCL grants only) *

Name
Title
Signature / Date

* Alternatively, pleaseprovide an email showingsupport for this application

Please return the completed and signed application to:

Guidance and notes on completing the application form

Grant Criteria and Eligibility

General notes

The allocation of grants from money raised for the ICC appeal is overseen Guy's and St Thomas' Charity Hospitals Cancer Fund Committee.

All grant holders are expected to demonstrate a commitment to fundraising for the appeal, without which grants would not be possible.

For larger applications in particular, please note that a significant lead-in time may be necessary for fundraising to meet the cost.

Please note that applications may be submitted for external peer review should the members judge this appropriate.

Who can apply

Staff who are employed by, or hold honorary contracts with, GSTT and whose work benefits cancer patients are eligible to apply.

What you can apply for

•Applications are invited from departments providing care to cancer patients for equipment, research, furnishings, refurbishment and other items benefiting patients and patient care which cannot be funded through NHS budgets or any other sources.

•Items or projects must directly support cancer care, items benefiting staff will not be considered (except qualifying applications for training – please see below)

•Applications to support individual, named patients are not eligible

•Your application must be for a minimum amount of £500. There is an upper limit of £20,000 although the committee might consider larger applications when necessary. Please bear in mind that the Committee has limited funds.

  • Research projects that seek to bring direct benefit to cancer patients and will directly translate into service, without requiring further research after the completed project. The applicants must seek approval and authorisation from all the relevant departments and governing bodies before an application is made.

What can’t you apply for

•Any activities or equipment which are covered by GSTT budgets.

•The committee will not consider your application if your department benefits from a Special Purpose Fund which could cover these costs. Contact for more information.

•Projects or items should be self-sustaining after the initial period, the Committee will not meet the costs of ongoing maintenance or other support

•No funding will be given to projects or activities which directly or indirectly benefit

GSTS, the public/private partnership for Trust pathology services.

Applications for training

A separate scheme operates to fund training and education for eligible staff members. Please contact for more information on accessing this scheme.

Urgency

Section C must be completed to indicate how urgent the item or project is. Items categorised as “urgent” must be fully justified.

Assistance for applicants

For help with this form, please contact:

The fundraising team supporting Guy’s and St Thomas’ raises money for Guy’s and St Thomas’ Charity, which then make grants to support the vital work of the hospitals.

Find out more at

or call 020 7848 4701

09.07.131