PA Hospital Centres for Health Research - 2016 Application Form for Research Excellence

Applications Close Midday Wednesday 18November2015

NHMRC Near-Miss Grants ($75,000)provide 12 months support toresearch studies submitted by MSH-based researchers for consideration in the current year’s NHMRC Project Grant round. Applications must have been deemed as being highly fundable (category 4) but failed to meet the NHMRC’s funding threshold.

NHMRC Infrastructure Supportis an initiative to reward research excellence by supporting the indirect cost of NHMRC funded research. Fractional support is provided to MSH-based Chief Investigators who are CIA and have secured an NHMRC grant that is administered by MSHor one of itsacademic partner universities (University of Queensland, Queensland University of Technology or Griffith University).An annual pro-rata amount of up to 5% of the annual NHMRC-awarded amountwill be provided.

Application Instructions

Refer to the 2016 PA Funding Guidelines for NHMRC Near-Miss Grants and NHMRC Infrastructure Support when preparing your application.

NoteCurrent recipients of NHMRCInfrastructure Support who will receive NHMRC funding for the same Project Grant in 2016 do not have to reapply.

All mandatory questions must be answered.

Press <Tab> to move between fields.

Complete all sections.

Submissions must include:

For NHMRC Near-Miss Grants

• Completed application form
• NHMRC GRP Assessment Summary letter
• NHMRC Application Summary
• Submitted NHMRC application Budget
• Ethicalclearance letter(s)– if appropriate
• MSH site specific approval letter(s) – if appropriate

For NHMRC Infrastructure Support

• Completed application form
• NHMRC Letter of Notification
• NHMRC Application Summary
• NHMRC Funding Schedule
• Ethical clearance letter(s) – if appropriate
• MSH site specific approval letter(s) – if appropriate

Submission

Applications must be submitted to the PAH Centres for Health Research via a two-step process:

Step 1: Paper submission

The hard copy, complete with signatures, must be either mailed to the PAH Centres for Health Research OR hand delivered to the Translational Research Institutereception desk.

Mailed applicationsmust be post-dated no later than Tuesday 17November 2015 and addressed to:

PA Research Grants Administration Officer

Princess Alexandra Hospital Centres for Health Research

Level 7, Translational Research Institute Pty Ltd

37 Kent Street

Woolloongabba Qld 4102

Step 2: Electronic submission

Electronic versions of the PA Research Support Scheme application formcontaining signatures will not be accepted.

PDF files of the PA Research Support Scheme application formwill not be accepted.

Email the application form and supporting documents outlined above . Files must not exceed 2 MB in size and should be named using the following naming convention:

Applicant Surname_2016[Grant type]_[Document type]

E.g., Smith_2016Near-Miss_Application

Grant types to be used for file naming include:

• Near-Miss
• Infrastructure

Document types to be used for file naming include:

For NHMRC Near-Miss applications:

• Application
• NHMRC GRP Assessment
• NHMRC AppSummary
• Requested Budget
• Ethics
• SSA

For NHMRC Infrastructure Support:

• Application
• NHMRC Notification Letter
• NHMRC App Summary
• NHMRC Funding Sched
• Ethics
• SSA

LATE OR INCOMPLETE APPLICATIONS WILL NOT BE ACCEPTED

Enquiries

Enquiries regarding the PA Research Support Scheme should be directed to:

Dr Megan Probyn, PAHResearch Grants Administration Officer

Email:

Tel:(07) 3443 8057

Please remove this and preceding pagesprior to submitting the paper version of your applicatioN

PA Research Support Scheme

2016Research Excellence Support Application

Research Support Application Type

Applicant INFORMATION (CIA)

Preferred Funding Body

Click to choosePrivate Practice Trust Fund (PPTF)PA Research Foundation (PARF)No preference (PPTF or PARF)

Acknolwedgement of SERTA grant payment conditions

(For applications to be considered for SERTA funding only)

I, [First Name, Surname], acknowledge and accept that grant payments from SERTA:

• Can only be made to a Metro South Health(MSH)employee with ≥0.5 FTE appointment.
• Must be deposited into a MSH research cost centre.

ApplicantSignature: ______Date:______

Applicant Eligibility Checklist

1. MSH (or hold a formal appointment to MSH) and engaged in clinical or health service delivery?
2. A PAH academic partner university school or research institute based on the PAH campus (UQ SOM, UQDI, QUT IHBI at TRI)?
3. Griffith University and based at a MSH site?

Mandatory Questions

1. Applicant Appointment Fraction and Location

Provide the FTE for each of your MSH/academic partner university appointment(s) (e.g. 0.6) and indicate where you are based (this information will assist with determining the appropriate funding body)

1. Applicant Appointment Details

Provide details of your MSH and/or academic partner university appointment(s) (maximum 300 characters including spaces)

• E.g.: Occupational Therapist at PA Hospital; MSH provides UQ with 50% of my salary

NOTE: N/A (or similar) will not be accepted

1. Location of research activity

Provide details of where the majority (more than 50%) of the research activity will take place (maximum 300 characters including spaces)

Note: The MSH site at which the TRI building is located is the PA Hospital

If the majority of the research cannot be conducted ata MSH site provide justification (maximum 300 characters including spaces)

For clinical research studies: If the MSH Governance Office has already approved the MSH site at which this study will be conducted, provide the site specific approval (SSA) number(s)

NOTE:

• Full funding of a successful clinical research application is conditional upon site specific approval being provided by the MSH Governance Office
• SSA approval letters must be sent to for the full award amount to be received

Eligibility Certification

I, [First Name, Surname], certify that I:

• Meet the relevant eligibility criteria for the PA Research Support Scheme.
• Have answered all mandatory questions.

Office use only

PA Research Support SchemeApplicant:

2016 Research Excellence ApplicationPage 1

Signature of Applicant: ______Date:______

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PA Research Support SchemeApplicant:

2016 Research Excellence ApplicationPage 1

1.NHMRC Near-Miss Grant applicantsonly

Provide details of the NHMRC Project grant application that was submitted in March 2015

**NHMRC weighted score = (50% x Scientific Quality) + (25% x Significance) + (25% x Track Record)

2.NHMRC Infrastructure Support applicants only

Provide details of the Project Grant currently funded/to be funded by the NHMRC

3.Human / Animal Experimentation

Refer to the National Health and Medical Research Council’s National Statement on Ethical Conduct in Human Research (2007 updated March 2014) and/or the Australian Code of Practice for the Care and Use of Animals for Scientific Purposes (8th edition 2013)

NOTE:

• Funding of a successful application is conditional upon ethical clearance of the proposed research
• Ethical clearance letter(s) must be sent to for funding to be received

4.Agreements and Certification of Support

I, [First Name, Surname], certify that written agreement (such as an email) has been obtained from all investigators named in this Research Support application and that all provided details are correct.

I understand that should this application be successful, all named Co-Investigators on this application will be required to sign the Acceptance of Offer.

On behalf of the investigative team, we accept and agree to comply with the ethical standards as set out by the National Health and Medical Research Council, and any additional standards required by the appropriate Human Research/Animal Ethics Committee.

I certify that research will not commence until all ethicalclearances and site specific approvals (SSAs), if required, have been obtained.

Office use only

PA Research Support SchemeApplicant:

2016 Research Excellence ApplicationPage 1

Signature of Applicant: ______Date: ______

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PA Research Support SchemeApplicant:

2016 Research Excellence ApplicationPage 1

Checklists

This checklist is for applicant purposes only.

Applications Close Midday Wednesday 18 November 2015

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PA Research Support SchemeApplicant:

2016 Research Excellence ApplicationPage 1