NETSCC Application Support Form for FULL Applications Only

NETSCC Application Support Form for FULL applications only

FULL APPLICATION- RESEARCH DETAILS

Main Form

Programme / Defaults to the programme you are applying for
Funding Opportunity / Defaults to the stream of funding you are applying for
Call / Defaults to the call you are applying for

Application Information

Host Organisation
The host organisation must be selected from our current list – you will need to contact the funding team if your organisation is not listed.
Research Title
Your full project title
(Limit 300 characters)
Application Type
Primary/Secondary/Evidence Synthesis
Proposed start date, duration (in months) (end date is calculated from start & duration for you)
Start date must be in the future and on the first of the month.
How did you hear about this call?
Select from drop down list or ‘other’ with description
(Limit 100 characters)
Total research costs requested (not including NHS support & treatment costs)
Requested research funding / Calculated automatically
Total NHS support & treatment costs
Proposed treatment costs could be savings / Calculated automatically
I have read the NIHR Carbon Reduction Guidelines
These can be found at This is mandatory to confirm you have read the carbon reduction guidelines. / Tick box
CONTACT INFORMATION
Details of Chief Investigator
Title
First Name
Middle Name (optional)
Last Name
Speciality
Organisation (Affiliated Organisation form)
You can select or add Affiliated Organisations as required. One must be your Primary organisation
Add or Edit Organisation Affiliation
Your organisation, job position and department.
Identify whether this is your Primary organisation and state your type of affiliation e.g. Employee or Board Member (select from a drop down list of values)
LEAD APPLICANT DETAILS

Lead Applicant Details

Specify Role in research
(Limit 200 characters)
% FTE commitment
Your proposed percentage of full time commitment to the research
Do you currently hold an NIHR award? / Yes/No selection
If yes please specify
(Limit 100 characters)
Date of commencement
dd/MM/yyyy
Is this a full time post? / Yes/No selection
If no, please give wte% (whole time equivalent)
Percentage of your work covered by this award
Current grade
Your current staff grade
Current Research Commitments
Summarise any current research commitments
(Limit 200 characters)
Lead Applicant Information – Please provide an approximate breakdown of how your current appointment is divided between the following activities:
Service/Clinical % / Research % / Teaching % / Other %
Please specify the other research activity
(Limit 100 characters)
Do you require or currently hold a working permit or visa? / Yes/No selection
If yes, please give details
(Limit 200 characters)
Are you on a fixed term contract? / Yes/No selection
If yes, please give details
(Limit 200 characters)
When does the contract expire?
dd/MM/yyyy
Will you require an honorary contract to complete this work? / Yes/No selection

Administrative Contact Details

Do you wish us to contact you, the lead applicant, regarding this application? / Yes/No selection
If no, provide administrative contact details (name, post held, department, organisation, contact details and access rights)
Edit Contact to enter details
On the Research Team page you will need to click Notify against this person so they can agree to participate and be sent login details
CURRICULUM VITAE

Degrees and Professional Qualifications

Add or Edit Degree or Professional Qualification
List your higher and professional qualifications. (Include subject, awarding body, class and date are mandatory items).
You will be asked to add these separately on the electronic form. Entries entered on previous applications will be shownas these are stored against the applicant.

Present and Previous Positions Held

Add or Update Present & Previous Employment Held currently or in the last 5 years
Please see funding programme guidance for suggested job history requirements. You will be asked to add these separately on the electronic form. Entries entered on previous applications will be shownas these are stored against the applicant.
Job title and Employing Organisation / Period of employment (From/To)
If this is a current post you will only need to enter a start date.

Patient / Service User or Carer Applicants

Are you (Lead Applicant) a patient/service user or carer?
You must respond to this question,
Yes/No Selection
If yes, please tell us about your knowledge, skills and experience that are relevant to this application. You are not required to provide a CV. Please read the guidance provided on information to include.
Only complete if lead applicant is a patient/service user or carer
(Limit 1000 characters)
RESEARCH CV

Recent Relevant Publications

Please provide a MAXIMUM of 6 of your most recent publications relevant to this application (using Vancouver or Harvard citation format) listed one after another with a blank line between each one.Please note if you choose to ‘view all publications held’ this will only show publications you have previously notified us about but you can copy and paste any publications relevant to this application from this list.
(overall limit 10,000 characters)

Research Grants Held

This should include research grants held (as a named applicant) CURRENTLYor IN THE LAST 3 YEARS – please include who the grant is with and the amount of each grant. If no grants are held please enter N/A (as this is a mandatory field).Please note if you choose to ‘view all grants held’ this will only show research grants you have previously notified us about but you can copy and paste any grants from this list.
Add a list of research grants in the text box with a blank line between each one.
Required information: Title, Source, Role in this research grant, Funding Period, Amount of Grant
(overall limit 10,000 characters)
RESEARCH TEAM
Role, Name, Organisation, Department, Post Held, Contact Details and Access rights, (None, Read Only (Excl financials), Edit Access (Excl Financials), Edit Access (Incl Financials)).

• Add your co-applicants for this proposal in this form. You will need their email address (preferably their organisation one) so that they can accept participation and contribute to the application by logging into the MIS providing certain cv information and any other contribution to the application that you have agreed with them. You control the level of access your co-applicants have to the application form. Access can currently be granted as Read only, Edit access excluding financial information or Edit access including financial information. Summary financial information can be seen by all applicants but not the detail. You can select and change this access at any time during your application process. If you have added a co-applicant in error or made a mistake with the email contact, you should delete this contact and add as a new contact. You will not be able to ‘amend’ this information on their record. Once you have added your co-applicants you can send them a notification from this form that will register them and invite them to contribute to the application by logging into the NETSCC MIS.

• Add the contacts that you have nominated as signatories for this application. As a minimum you should provide contact information for a Sponsor, Financial Director / Administrative Authority and Head of Departmen- see programme guidance information for further details. You will need their email address so that they can accept their participation and contribute to the application by logging into the MIS to accept their role and electronically ‘sign’ the application after submission.

You also have the opportunity to add an administrative contact and allow them full access to the application to support you in its completion.
PATIENT AND PUBLIC INVOLVEMENT (PPI)
Were patients and the public actively involved in identifying the research topic or prioritising the research questions? / Yes/No selection
Were patients and the public actively involved in preparing this application? / Yes/No selection
If yes to eitheror both of these questions, please give details. Describe how patient and public involvement has informed and/or influenced the development of the application and how patients and the public have been involved.
(Limit 1200 Characters)
If no to either orboth of the previous questions, please explain why patient and public involvement was not necessary.
(Limit 1200 Characters)
Planned patient/public active involvement in proposed research
Please indicate the ways in which patients and the public will be actively involved in the proposed research. Tick all relevant boxes.
This is a selection list and you should select as many of the check boxes as are relevant. Depending on the responses you should complete the additional questions in the following two boxes.
☐Design of the research
☐Management of the research (eg steering/advisory group)
☐Developing participant information resources
☐Undertaking/analysing the research (e.g. member of research team)
☐Contributing to the reporting of the research
☐Dissemination of research findings
☐Other
☐ No plans for involvement
If active involvement is planned, please give more details, including how it will benefit the research, the reasons for taking this approach and arrangements for training and support.
You will need to complete this if you have selected any items in the list. (Limit 1200 Characters)
If there are no plans for active involvement, please explain why it is not thought necessary.
You will need to complete if you have not selected any of the items in the previous list. (Limit 1200 Characters)
HISTORY OF APPLICATION

Previous Submission

Has this application, or a similar application previously been submitted to this or any other funding body? / Yes/No selection
Application(s) Submitted to NETS programmes (since 1 April 2012)
Any previous applications that you have submitted to NETS programmes since 1 Apr 2012 will be listed in this section. You have the opportunity to identify if they are relevant (yes/no) to this current application and to Edit information as described in the two questions below.
Other Funders / Applications in Progress
You can Add any applications in progress submitted to other funders in this section using the add facility.
Required information
Project Title: (Limit 300 characters)
Funding Body: (Limit 100 characters)
Funding Scheme: (Limit 100 characters)
Application Reference Number: (Limit 30 characters)
Application Type: Select from Expression of Interest, Outline, Full or Other
Outcome: Select from Pending Decision, Funded, Not Funded, Provisionally Funded, Funded with Revisions
Date of Outcome: dd/MM/yyyy

Description of Funding

Please indicate how your current research proposal differs from this previous application
Required information
(Limit 1500 characters)
If unsuccessful, please indicate why
Required information
(Limit 1500 characters)

APPLICANT’S INFORMATION

CASE FOR SUPPORT

Title and Abstract

Scientific Abstract
See funding opportunity guidance
(Limit 3500 characters)
Summary (in plain English)
See funding opportunity guidance
(Limit 3500 characters)
RESEARCH PLAN

The list below is the full list of questions that could be asked in this section. Each call may have a different subset of these questions so please check Guidance Notes or the online version before answering these questions. On the screen, you access the response section by clicking on the ‘add’ button. Please note if the response is required (yes under the ‘Required' column in this section) you will need to complete the response. View the Research Plan page of the online form to see thequestions that are relevant to the call to which you are applying. You should enter N/A if you do not have any comments to make

See the funding opportunity guidance when answering any of these questions.

Question / Response
Address Feedback from First Stage
Provide feedback from the first stage of the application process that you have taken into account in this proposal (if this is the first application please enter N/A if an answer is “required” for this question)
(Limit 1500 characters)
Additional Alterations
Provide details of any further alterations you have made since the first stage of the application process (if this is the first application please enter N/A if an answer is “required” for this question.)
(Limit 2500 characters)
MeSH Terms
Please provide any MeSH terms that relate to this proposal.
(Limit 1500 characters)
Design
Please provide a plan for the research design.
You may wish or be asked to upload supporting documents to accompany this response.
(Limit 4000 characters)
Design – EME (EME calls only)
Please provide a brief description of the project profile.
You may wish or be asked to upload supporting documents to accompany this response.
(Limit 8000 characters)
Setting
Please provide a research plan for the setting.
You may wish or be asked to upload supporting documents to accompany this response.
(Limit 1500 characters)
Target Population
(Limit 1500 characters)
Inclusion/exclusion criteria
(Limit 2500 characters)
Health Technology
Please provide details of the Health Technology being assessed.
(Limit 2500 characters)
Control Treatment
Please provide details of the control treatment.
(Limit 2500 characters)
Planned Interventions
Please provide details of the Planned interventions.
You may wish or be asked to upload supporting documents to accompany this response.
(Limit 2500 characters)
Who will deliver the intervention(s)?
(Limit 1500 characters)
Proposed Outcome Measures
(Limit 2500 characters)
Search Strategy
(Limit 2500 characters)
Review Strategy
(Limit 2500 characters)
Assessment and Follow Up
(Limit 2500 characters)
Sample Size
(Limit 2500 characters)
Statistical Analysis
(Limit 2500 characters)
Care Pathways in comparative or randomised trials
(Limit 2000 characters)
Differences between current standard care pathway and planned
(Limit 1500 characters)
Network Support
Please identify any Clinical Research Networks your project is associated with and provide a brief summary of their support
(Limit 2500 characters)
Programme Remit
Explain how the proposed research is within the programme remit, and for commissioned calls, how the proposed research is within the commissioning brief
(Limit 3500 characters)
Mechanistic Studies
Please provide details of any mechanistic components of your study
(Limit 1500 characters)
BACKGROUND AND RATIONALE
What is the problem being addressed?
See funding opportunity guidance
(Limit 2000 characters)
Why is the research important in terms of improving the health of the public and/or to patients and the NHS?
See funding opportunity guidance particularly for responses in this section
(Limit 3500 characters)
Please provide evidence explaining why this research is needed now (how does the existing literature support this proposal)?
See funding opportunity guidance
(Limit 2000 characters)
Aims and Objectives
See funding opportunity guidance
(Limit 3000 characters)
CHANGES FROM FIRST STAGE

Changes from the first stage1/Outline Stage

How has this changed from the first stage application?
See funding opportunity guidance. Only complete if there has been a previous stage to this application otherwise enter N/A in this response.
(Limit 3500 characters)
DISSEMINATION AND OUTPUT
Please describe your plans for disseminating the findings of this research.
See funding opportunity guidance.
(Limit 2500 characters)
Expected Output of Research/Impact
See funding opportunity guidance.
(Limit 2500 characters)
RELEVANT EXPERTISE
Strengths of Research Team – contribution of each member
See funding opportunity guidance
If known, you should identify your planned co-applicants and their institutions, the role they will take and the strengths of individuals to the team.
(Limit 2000 characters)
Please declare any conflicts or potential conflicts of interest that you or your co-applicants may have in undertaking this research, including any relevant, non-personal & commercial interest that could be perceived as a conflict of interest.
See funding opportunity guidance. (Limit 2000 characters)

O

DETAILED BUDGET
Budget Years
Identify the number of years for the proposed research – See funding opportunity guidance

Posts and Salaries – Details

Lead Applicant and Co-Applicants

Lead Applicant and Co-Applicants Information
Name, Organisation, Role, Pay Grade, Increment Date / Salary
Current Salary / Weighting
Geographical Weighting / Other Allowances / Superann. And Nat. Insurance / Current Annual Costs

Research Staff

Research Staff Information
Name, Organisation, Role, Pay Grade, Increment Date / Salary
Current salary / Weighting
Geographical Weighting / Other Allowances / Superann. And Nat. Insurance / Current Annual Costs

Shared Staff

Shared Staff Information
Name, Organisation, Role, Pay Grade, Increment Date / Salary
Current salary / Weighting
Geographical Weighting / Other Allowances / Superann. And Nat. Insurance / Current Annual Costs

Other Staff

Other Staff Information
Name, Organisation, Role, Pay Grade, Increment Date / Salary
Current Salary / Weighting
Geographical Weighting / Other Allowances / Superann. And Nat. Insurance / Current Annual Costs
NETSCC Full Application - This is not a valid Application form
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