Medical Research Support Program: Standard Application Form
Closing Date – Wednesday 17 February
NSW HEALTH EARLY-MID CAREER FELLOWSHIPS
EXPRESSION OF INTEREST
Closing date 3 October 2017
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NSW Health Early-Mid Career Fellowships 2017 - Expression of Interest
INSTRUCTIONS FOR COMPLETING AND SUBMITTING EXPRESSIONS OF INTEREST (EOI)
Please refer to the EMC Fellowships 2017-2020 Application Guidelines at http://www.health.nsw.gov.au/ohmr/Publications/emc-fellowships-application-guidelines.pdf for Eligibility Criteria.
The EOI must be submitted by email to by 5pm, 3 October 2017.
List of References could be attached with the EOI. This will not be included in the word limit.
OVERVIEW
Fellow details
Full Name
Including title
Phone number
Date awarded / By / University namePhD (recognised in Australia)
Or equivalent
Identify at least one EMC Fellowship skill development area you wish to develop
The skill development areas may include: health service and systems design, implementation science, epidemiology, medical and bioinformatics, health economics, biostatistics, health policy development or laboratory skills. You can also nominate other skills including skill development related to Basic Science.
Is your research primarily: A Biomedical/Basic ☐ A ☐ B ☐ C
B: Clinical or Clinical Trial C: Public/Population Health
or Health Service Research
Does your research focus on cardiovascular health? ☐ Yes ☐ No
Are you currently a practicing clinician? ☐ Yes ☐ No
If yes, do you intend to continue clinical duties ☐ Yes ☐ No ☐ N/A
during the term of the fellowship?
Are you applying for Full Fellowship (Fellowship and Project funding)? ☐ Yes ☐ No
Are you an existing Fellow applying for Project funding only? ☐ Yes ☐ No
(at least 2 years must be left on the Fellowship)
Provide details of Fellowship
Copy of successful application
Other grants held
Current funding source, amount, years left etc.
Are you an Australian Citizen/Permanent Resident? ☐ Yes ☐ No
Non-Australian Citizens/Non-Permanent Residents are required to provide evidence of residency status and the right to remain in Australia for the duration of the funding period, see Guidelines for more detail.
Host Organisation details (where Fellowship will be undertaken)
Organisation
Name
Organisation
Address
Name and contact detailsAdministrative contact
Supervisor details
Full Name
Including title
Position and
institution
Phone number
Executive summary
Please provide an overview of your qualifications, research experience and track record including funding and publication highlights (700 words maximum).
Research proposal
Briefly describe your research project. Include project title, research focus, rationale (evidence gaps your research will explore) and study methodology (700 words maximum).
Skill development plan
Briefly describe your skill development plans. Illustrate the skills you will develop during the Fellowship (700 words maximum).
How will your proposed research translate into better patient outcomes?
Include clinical relevance, clinical impact, health system impact (including changes to models of care) and patient population that will benefit from translation of research findings to health practice and or policy or if your project has a basic/biomedical science focus, how your research could impact on future diagnosis, prevention or management of cardiovascular disease (700 words maximum).
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