For Official Use Only
PROGRAMME NAME
Irish Cancer Society-SFI Collaborate Cancer Research Centre
TITLE OF PROPOSAL (up to 30 words)
Enter text here
FULL NAME OF LEAD APPLICANT
Enter text here / HOST INSTITUTION
Enter text here
TOTAL REQUESTED BUDGET (€)
Enter text here / TOTAL INDUSTRY CASH CONTRIBUTION (€)
Enter text here
REQUESTED STARTING DATE
01/01/2015 / PROPOSED DURATION
60 Months
Signatures below confirm acceptance and agreement with the SFI grants and awards Terms and Conditions, and that the institution ensures the applicant meets eligibility requirements, and that the project is in full agreement with all legal and regulatory matters governing research in Ireland, and no aspect of this project is already being funded from another source and all details provided are correct.
INSTITUTIONAL SIGNATORY AUTHORITY
Name:
Position:
Email:
Signed:
Date: / TECHNOLOGY TRANSFER OFFICE
Name:
Position:
Email:
Signed:
Date:
Comment from TTO Director/Officer

Irish Cancer Society Remit Justification(max. 250 words)

Applicants are required to complete a brief statement justifying how the application aligns with the strategy of the Irish Cancer Society, as outlined in its “Towards a Future without Cancer” Strategy Statement 2013-2017. The statement must describe the potential societal impact of the proposed research to both cancer patients and the public. For further information of the Irish Cancer Society’s“Towards a Future without Cancer” Strategy Statement 2013-2017.

SFI Remit Justification(max. 250 words)

Applicants are required to complete a brief statement justifying that the application is within SFI’s legal remit. The statement must describe how the proposed research is oriented basic or applied research which promotes or assists the development and competitiveness of industry, enterprise and employment in Ireland. For further information on SFI’s legal remit can be found on the SFI website

Eligibility Criteria

Applicants are required to confirm that they have read and understood the eligibility criteria described in the call document, and confirm that they are eligible to apply to this call.

Please confirm that you have read and understood the eligibility criteria in the relevant call document, and that you are eligible to apply to this call? / ☐

Irish Cancer society-SFI Collaborative Cancer Research Centre

STAGE 1- Pre-Proposal APPLICATION FORM

[INSERT CENTRE TITLE]

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IMPORTANT NOTICE: The cALL DOCUMENT must be read carefully before completing this Stage 1 - Pre-Proposal Application Form

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  1. Contact Details

Lead Applicant

Lead Applicant
Title and Name:
Institution:
Position:
Email:
Telephone Number:
Correspondence Address:
% Time Commitment:

Co-Applicant

Co-Applicant [copy table as required (max. 9 Co-Applicants)]
Title and Name:
Institution:
Position:
Email:
Telephone Number:
Correspondence Address:
% Time Commitment:

Official Collaborators

Official Collaborator (copy table as required)
Title and Name:
Institution:
Position:
Email:
Telephone Number:
Correspondence Address:
  1. Collaborative Centre Summary

2.1Scientific Abstract (max. 250 words)

2.2Lay abstract (max. 250 words)

2.3Research Theme (max. 100 words)

2.4Keywords

  1. Collaborative Centre ResearchGroup

3.1Profile of the ApplicantGroup and Proposed Collaborative Structure(max. 2pages)

  1. Research Programme

4.1Research Programme Description(max. 5 pages)

4.2 References

  1. Impact Statement and Industry Engagement Plan (max. 5 pages)
  1. Budget Summary

6.1 Overall Collaborative Centre Budget

Table 1. Total Centre Budget
Irish Cancer Society-SFI Collaborative Cancer Research Centre
Year 1 / Year 2 / Year 3 / Year 4 / Year 5 / Total
Industrial Cash / -
Industry In Kind Contribution / -
Requested Irish Cancer Society-SFI Contribution / -
TOTAL CENTRE BUDGET / - / - / - / - / - / -

6.2IndicativeBudget(max. 2 pages)

Table 2. IndicativeBudget
Irish Cancer Society-SFI Collaborative Cancer Research Centre
Year 1 / Year 2 / Year 3 / Year 4 / Year 5
  1. Staff

i) Salaries (including PRSI, Pension)
ii) Student Stipends
iii) Student Fees
Total Staff Costs / € / € / € / € / €
B. Materials
C. Equipment
D. Travel
Total (B + C + D) / € / € / € / € / €
Yearly Grand Totals / € / € / € / € / €
Grand Total of Centre / €

6.3 Budget Breakdown by Research Programme Area

Table 3. Budget Breakdown by Research Programme Area
Irish Cancer Society-SFI Collaborative Cancer Research Centre
Year 1 / Year 2 / Year 3 / Year 4 / Year 5 / Total
Research Programme 1 / €
Research Programme 2 / €
Research Programme 3 / €
Research Programme 4 / €
Total Direct Costs / € / € / € / € / € / €

*Insert additional rows as required

6.4Budget Justification (max. 1page)

6.5 Funding History

Table 4. Funding History
Name of Applicant / Co-Applicant / Grant Title / Grant Code / Granting Body / Award Date / Total Grant Value / Applicant / Co-Applicant Share
Total / €X / €Y

6.6Other sources of funding

  1. Letters of Support

Summary Breakdown of Industry Partner Contribution

INDUSTRY PARTNER “X” CONTRIBUTIONS
Year 1 / Year 2 / Year 3 / Year 4 / Year 5 / Total
Cash Contribution
Staff Contribution
Equipment Contribution
Other In-Kind Contribution

Summary of Official Collaborator Contribution

OFFICIAL COLLABORATOR
Collaborator Name / Collaborating Institute / Area of Expertise / Contribution to Collaborative Centre
  1. Signature Pages

Collaborative Cancer Research Centre Pre-proposal Signature Pages

Page 1 of 2

Irish Cancer Society Collaborative Cancer Research Centre
Title of Proposal:
Name of Lead Applicant:
Signed by Lead Applicant:
Date:
Name of Participating Institution:
Authorised Signatory of Research Institution of Lead Applicant
Name:
Position:
Email:
Address:
Signed:
Date:
Institutional Stamp:

Collaborative Cancer Research Centre Pre-proposal Signature Pages

Page 2 of 2

Co-Applicant Signatures

Name 1: / Signature:
Name 2: / Signature:
Name 3: / Signature:
Name 4: / Signature:
Name 5: / Signature:
Name 6: / Signature:
Name 7: / Signature:
Name 8: / Signature:
Name 9: / Signature:

Appendix A – Curricula Vitae

Appendix B – Letters of Support

1

Irish Cancer Society-SFI Collaborative Cancer Research Centre – Pre-Proposal Form