Health and Care Research Wales

Health and Care Research Wales

HealthStudentship Award2018

Themed Call

ApplicationForm

‘Does co-production increase the sustainability of public services?’

Please refer to the Guidance Notesand Theme Briefdocuments when completing this Application Form.

The Application Form (including applicant CV) should be submitted electronically with authorised signatures (scanned or electronic) to the address below by 4pm on 27th March 2018, and include a covering email from the Applicant (Supervisor), to:

If you would like to discuss your application prior to submission, please contact Health and Care Research Wales at the above address.

SECTION A: Applicant Details

1. Project details

1. Title of project

2. Applicant details

Name
Current Position held
Email
Telephone

3. Host Institution details

Institution
Finance Officer
Finance Tel No.
Finance Officer email
Contact address

SECTION B: Project Details

4. Cost and duration

Please enter the total cost of your project toHealth and Care Research Wales and start and completion dates:

Cost (£)
Start date
Proposed end date

5. Lay summary(word limit: 300)

6. Keywords

Keywords:

7. Themed call
(Note: this form is for the Themed Call. If you are not applying to the Themed call, please use the General Call Application Form)

7a)Please describe how the proposed research addressesthe theme‘Does co-production increase the sustainability of public services?’ (word limit: 500)

7b)In addition, please indicate which of the general priority areas your application addresses:

Prevention and early intervention
Management of chronic conditions
Service organisation and delivery

8. Need and impact (word limit: 500)

9. Timetable and milestones

Please give an indicative timetable for the project noting the key milestones.(Please add more rows as necessary)

Date / Milestones

10. Detailed project description (word limit: 3,000)

Please use the headingsbelow when structuring your answer.

•Aims and objectives:
•Design and method:
•Use of resources:
•Method of analysis:
•Expected outputs and outcomes:
•Dissemination:

11.Ethical considerations and approval(word limit: 300)

12. Public Involvement(word limit: 500)

13. Other applications for funding

SECTION C: Environment

14.Research Environmentand high quality research group(word limit: 500)

15. Contribution and track record of the PhD Supervisor(word limit: 300)

16. Training and development (word limit: 300)

SECTION D: Resources

17. Resources

Detailed breakdown of project costs:

Resource / Year 1 / Year 2 / Year 3 / Total
Directly Incurred
Consumables
Travel & Subsistence
(Student)
Training & Development
Equipment
Other (please specify)
Exceptions*
Stipend / £14,979 / £14,979 / £14,979 / £44,937
Tuition Fees
Total
VAT (if applicable)
Grand Total

*Please note, asstudentships are regarded as an ‘exception’ under Full Economic Costing (FEC), Health and Care Research Wales will not provide funding for these awards under ‘directly allocated costs’ and ‘indirect costs.

SECTION E: Declarations and CV

18. Declarations

18a.Applicant (PhD Supervisor)¹ declaration:

I declare that I have completed the application form in accordance with the guidance notes and confirm that the information provided is accurate to the best of my knowledge. I declare that I will supervise the academic activities funded under the Studentship Award should the application be successful.

Signed:

Name:

Date:

18b.Host Institution declaration:

This application should be submitted through the Head of Department and the Administrative Authority, based at the Host Institution, who will be responsible for administering the grant. Both must sign below to confirm that they have read and agreed to the following declaration:

I confirm that I have read this application and that, if this application is successful, the work will be accommodated and administered within this body in accordance with the terms and conditions that will form the contractual obligations. All costs are correct and in accordance with the normal practice of this institution.

Head of Department / Administrative Authority
Name and initials:
Title:
Institution:
Address:
Contact number:
Signed:
Date:

19.Applicant CV

Personal details
Title:
Name:
Current job held:
Institution:
Address:
Phone:
Email:
Experience
Research experience:
Qualifications:
PhD supervision experience:
Work history:
Significant grants won:
Publications:

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Thank you for completing this application form.