*Standard Application Form*Form Template draft

STANDARD APPLICATIONFORM

Section: Introduction

Please note the following information and guidance is provided to applicants submitting an i4i stage 2 application ONLY.

There are a number of resources available to you throughout the online form to help guide you when submitting a research application and it is advised that you take care to read theguidance for applicantsdocument as well as the online guidance prompts(marked as a?) carefully whilst completing your application

The deadline for this call is 1pm on Wednesday 27 September 2017

Please ensure that all co-applicants invited to collaborate on this application have confirmed their involvement and approval of the application form contentwell in advanceof this deadline.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.

Host organisation(which will administer any award)

If your organisation does not appear on this list, please contact theCentral Commissioning Facility.

Please indicate which organisation would act as the contracting organisation if the application is successful.
NOTE: If your organisation does not appear on this list, please contact the Central Commissioning Facility.

Research duration

Please indicate the expected length of the proposed projects in months.
NOTE: i4i Challenge Award projects can be up to a maximum of 60 months in duration.

Proposed start date if awarded funding

(Cannot be before 01/04/2018)

Please indicate the proposed date on which the project would start.
A 'cannot be before' date has been suggested on your behalf to ensure that there is sufficient time for pre-contract due diligence, which is carried out by the i4i Secretariat prior to concluding the contract to confirm IP arrangements and the commercial strategy, to agree the exact amount of funding and the payment schedule, and to agree reporting requirements and stage gates for funding.
NOTE: You may not know this date exactly, but a rough estimate must be supplied.

Section: Lead ApplicantDetails

Some of the responses required in this section of the form will have been pre-populated based on your CV details. Please complete the remainder of this section.

Full NameORCID iD

PositionAddress Line 1

SpeciailtyAddress Line 2

InstitutionAddress Line 3

City/Town

Email Address

Please ensure that your role on this research and %FTE commitment information is detailed within the ‘Co-Applicant Details’ section.

Provide an approximate breakdown (%) of how your current appointment is divided between the following activities:

Please use this section to provide an approximate breakdown of how your time is currently divided.
%
Service/Clinical
Research
Teaching
Other

If applicable, please specify what your 'other' research activity consists of.

(20 words max)

Administrative Contact Details

Please provide details foran administrative contact who you would wish to act as a secondary point of contact for any queries relating to the proposed project, should it be supported.
NOTE: This person does not need to be a co-applicant.

Administrative contact name

Administrative contact job title

Administrative contact telephone number

Administrative contact email address

Section: Applicant Publication Details

Please note that relevant publication details must be added by each individual applicant on this page.

Select and order what you consider to be your ten most relevant publications to this application to date:

  • Applicants should update their list of publications in theManage My Detailssection.
  • Applicants should add up to ten publications relevant to the application using the green “+”icon.
  • Use the delete icon (-)to remove a publication from the list.
  • Click and drag the arrow icon to change the order of each publication.
  • The save button must be used to save the selections in their respective order.

To update your publications, please visit theManage My Detailsarea by selecting 'Save and Close' at the top of this screen and accessing theleft handmenu toolbar. Once inManage My Details, the publications are available via theUpdate CVsection of your account.

Add Publication...

Degrees

(including details of degree subject/professional qualification(s), awarding body and date)

Please ensure that your CV details are up to date.

Present and previous positions held or experience of service user

(including job title, employing organisation, and start/end dates)

Please ensure that your CV details are up to date.

Selected recent relevant publication(s)

(including list of authors, article title, publication name, volume reference)

Please ensure that your CV details are up to date.

Research awards(s) held

Please ensure that your CV details are up to date.

Reference: i4i – stage 2 Date received: 13 June 2016

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*Standard Application Form*Form Template draft

Section: Co-applicantDetails

Co-applicant

Please note there is a maximum limit of 12 co-applicants.

All co-applicants are expected to make a substantive contribution to the managementand delivery of the programme.To reflect this, each co-applicant invitedmusthave confirmed and approved this application before the submission deadline.

Please note completed CVs for all co-applicants are a mandatory requirement for submission and will be ‘pulled through’ into the application. To update these details, a co-applicant should visit the Manage My Detailssection by selecting 'Save and Close' at the top of this screen,accessing the left hand menu toolbar.

However, co-applicants who are patients, service users or carers are not obliged to complete a standard CV but are required to provide a summary of any knowledge, skills and experience relevant to their role in the application. A separate text box is provided for this purpose in the 'Add applicant role and %FTE commitment...' section.

All key contributors to the project must be represented as co-applicants.
Project teams must have demonstrable experience in all areas relevant to carry out the project, including scientific, technical, clinical, project management, intellectual property, commercial and regulatory experience as required. Specialist services or expertise may be brought into the team through consultancy or sub-contract arrangements, however, appropriate justification must be provided in the ‘Case for Support’ and ‘Finance’ sections
NOTE: Please note that co-applicants who are patients, service users or carers are not obliged to complete a standard CV but are required to provide a summary of any knowledge, skills and experience relevant to their role in the application. A separate text box is provided for this purpose in the ‘Add applicant role and % FTE commitment...’ section.

Add co-applicant

POP UP TEXT
Please note if the relevant individual does not immediately appear on this list, ensure that your search criteria are accurate and refined, using both Forename and Surname fields.
Forename
Surname

The section below, including the finance section, must be completed for each applicant.

Add Applicant role and %FTE commitment…

Please select the name of the applicant from the drop down list below.

Name of applicant

Please note a colleague should first be ‘invited’, once this has been completed their details will automatically appear in the field below.

The i4i programme is a collaborative research and development programme, and the co-applicants listed here are expected to reflect this. Where appropriate, please include details of those who will be responsible for research, project management, IP and commercial aspects of the project, making sure that there is at least one representative from each organisation involved.
NOTE: Please see separate programme guidance document for further information.

Is this a patient/public co-applicant? Yes/No

If yes

Co-applicants who are patients, service users or carers are are not obliged to complete a standard CV but are required to provide a summary of any knowledge, skills and experience relevant to their role in the application.

We recognise and value the varied perspectives that patients/service users and carers bring to a project as applicants. In this section, please provide a summary of any relevant knowledge, skills and experience that you will draw upon to contribute to this project.
This could include information about:
  • Previous or present work (paid or unpaid) with any relevant organisations
  • Links with any relevant groups, committees, networks or organisations
  • Experience of particular health conditions, treatments, use of services - or as a member of a particular community
  • Knowledge and experience of research including previous research undertaken
  • Knowledge and experience of patient and public involvement including previous involvement activities
  • Skills from any other roles that are transferable
  • Relevant qualifications, training and learning.
The bullet point list above is not exhaustive. Please include anything else that is relevant to the application.
(500 words max)

Specify role in research

Each co-applicant should provide a brief overview of their role in the proposed project. Further description of their day-to-day contribution to theproject can be made within the 'relevant expertise and experience' section in the Case for Support.
(300 words max)

%FTE commitment

Each co-applicant should include the percentage of time that they will devote to the project.
NOTE: Full-Time Equivalency (FTE) = percentage of full-time hours per week.

Reference: i4i – stage 2 Date received: 13 June 2016

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*Standard Application Form*Form Template draft

Section: Research & Development office contact

Please note we will notify the R&D office of the outcome of this application including any associated feedback.

Host institution(which will administer any award)

This will be the host organisation previously specified.

R&D contact name

Please provide the name, contact details and job title of the contact person in the R&D office of the contracting organisationso that we are able to notify this person of the outcome of this application including any associated feedback. In the event of this project being recommended for funding, we would also need to communicate with this person with regards to contract negotiations and general management of the project throughout its duration.
NOTE: Please note this person does not need to be included as a co-applicant.

R&D contact job title

R&D contact telephone number

R&D contact email address

Section: History of this application

Has this application, or a similar application previously been submitted to this or any other funding body?

YesNo

Select 'Yes' if this application, or part of this application, has been submitted to another funding organisation or other National Institute for Health Research or Department of Health funding scheme previously.

Title of previous application

Provide the full research title for the application.
(100 words max)

Name of Lead Applicant

Funding body to whom it was submitted

Identify the organisation to which it was submitted previously.

Funding scheme under which the application was submitted

Identify the funding scheme to which it was submitted previously.

Please indicate whether this was a Stage 1 (outline) or Stage 2 (full) application.

(Select)

The reference number of previous application

Provide the reference number for the application.

Outcome

Funded

Pending

Unsuccessful

Please state the outcome date, if a decision is still pending.

calendar view (dd/mm/yyyy)

If unsuccessful, please indicate why.

(200words max)

Where a previous, related application was made, please indicate how this research proposal differs from the previous application.

You should highlight both successful and unsuccessful applications that weresubmitted to anyfunding organisation.
For unsuccessful applications, please summarise any changes made to the project in response to any feedback received.
NOTE: Where there is a previously successful i4i application, please describe how this project follows on from the funding received.
(200 words max)
Section: Patient & Public Involvement

In this section it is important that you describe, in as much detail as possible, how patients and the public have been involved in the development of the application as well as plans for involvement in the proposed research.

The NIHR expects the active involvement of patients and the public in the research it supports. NIHR recognises that the nature and extent of active patient and public involvement (PPI) is likely to vary depending on the context of each study or award.
The Guidance for Applicants document provides more information on PPI in research.
In addition: a definition of patient and public involvement in research, further information and resources are available fromINVOLVE; the NIHRResearch Design Serviceprovides advice on applications and theJames Lind Alliancehas a step-by-step guidebook on involvement in research identification and priority setting.

Were patients and the public actively involved in identifying the research topic/prioritising the research questions and/or preparing this application?

YesNo

If ' Yes' box is ticked the following text appears:

If yes, please tick the appropriate boxes below.

Involved in identifying the research topic/prioritising the research questions
Involved in preparing the application

Please further describe how patient and public involvement has informed and/or influenced the development of the application and how patients and the public have been actively involved.

If you have selected either of the boxes above please further describe the aims of the involvement and the ways in which you have involved patients and the public.
Explain how patient and public involvement has informed and/or influenced the development of the research application including any of the following:
  • Identification and/or prioritisation of the research topic
  • Identification and/or prioritisation of the research questions
  • Development of the research design
  • Preparation of the application
(300words max)

If 'No' box is ticked the following text appears:

If patients and the public were notactively involved please explain why patient and public involvement was not thought necessary.

(200 words max)

Please indicate the ways in which the public will be actively involved in the proposed research, by ticking all the relevant boxes below.

Design of the research
Management of the research (e.g. steering/advisory group)
Developing participant information resources
Undertaking/analysing the research (e.g. member of the research team)
Contributing to the reporting of the study report
Dissemination of research findings
No plans for involvement
Other
If ‘Other’ box is ticked the following text appears:
Please explain how patients and the public have been actively involved in other ways.
(100 words max)
If any of the above box(es) are ticked the following text appears (N/A if box ticked 'no plans for involvement') :
Please give more details, including how patient and public involvement will benefit the research, the reasons for taking this approach and arrangements for training and support.
For the boxes ticked above, please outline:
-the aims of the patient and public involvement,
-the ways in which patients and the public will be involved (where appropriate, provide -names of individuals and/or groups (with consent)) and
-a description of any plans for training and/or support.
Please note that a budget line for the costs of patient and public involvement is included in the finance section which applicants are expected to complete.
For further information you can access an involvement cost calculator and budgeting guide via INVOLVE's website.
(350 words max)

if ticked 'no plans for involvement' box the following text appears :

If there are no plans for active involvement please explain why it is not necessary.

(150words max)

Section: Case for Support- Part 1

Research title

This is the full research title of your application as detailed within the initial 'Research Details' section. Please do not amend this unless you wish to amend the title of your application.
NOTE: This is largely administrative and has been autopopulated based on your previous entry within the 'Research Details' section.

Aims and objectives

This section should be used to indicate the main aims/objectives of the proposed research.

This section should be used to indicate the main aims/objectives of the proposed project.
Projects in this programme will vary considerably in their design; however, it is expected that applicants will clearly describe:
  • The technology to be developed
  • Key aims for the project
  • Main hurdles to be overcome technically, clinically and commercially
  • Key measures of success
  • How the funding will be utilised to achieve the goals set out
NOTE: The inclusion of a diagram(s), picture(s) or figure(s) to aid description of the technology being developed can be included as part of the “Supporting Documentation” section. Please ensure that any supporting diagrams, pictures or figures are clearly described.
(450 words max)

Plain English summary

Please summarise your proposed research in plain English.

The importance of a plain English summary
A plain English summary is a clear explanation of your research.
Many reviewers use this summary to inform their review of your funding application. They include clinicians and researchers who do not have specialist knowledge of your field as well as members of the public. If your application for funding is successful, the summary will be used on National Institute for Health Research (NIHR) and other websites.
A good quality plain English summary providing an easy to read overview of your whole study will help:
  • those carrying out the review (reviewers and board and panel members) to have a better understanding of your research proposal
  • inform others about your research such as members of the public, health professionals, policy makers and the media
  • the research funders to publicise the research that they fund.
If we feel that your plain English summary is not clear and of a good quality then you may be required to amend your summary prior to final funding approval.
It is helpful to involve patients / carers / members of the public in developing a plain English summary.
Content
When writing your summary consider including the following information where appropriate:
  • aim(s) of the research
  • background to the research
  • design and methods used
  • patient and public involvement
  • dissemination.
The plain English summary is not the same as a scientific abstract - please do not cut and paste this or other sections of your application form to create the plain English summary.
Further guidance on writing in plain English is available online at NIHR Make it clear .
For further support and advice on writing a plain English summary, please contact your local Research Design Service (where applicable).
(300 words max)

Scientific abstract of research