PARKES FOUNDATION

SMALL GRANT FUND APPLICATION FORM 2016

Please complete and return by 8 JANUARY 2016

by email to The Executive Secretary ()

The secretary will acknowledge all applications received and will then contact applicants' referees. If no acknowledgement is received within a week of submission, applicants should contact the secretary.

ONLY CORRECTLY FORMATTED APPLICATIONS WILL BE ACCEPTED

§  Complete in Times New Roman font size 10 only

§  Do NOT exceed FIVE A4 pages in length

§  Do NOT attach additional documents (e.g. CV etc.)

§  Do NOT change formatting (e.g. file format, width of margin etc.)

TITLE OF PROPOSED RESEARCH
(do not use bold) / FIELD OF APPLICATION
(choose one only and mark X in the box)
Reproduction
Demography
Fertility
Human Health (including HIV/AIDS)
Conservation
Human Genetics
TITLE (Mr/Ms) / SURNAME / FIRST NAME / DATE OF BIRTH
(DD/MM/YY) / EMAIL
ADDRESS FOR CORRESPONDENCE
TELEPHONE:
CURRENT AFFILIATION
(e.g. Department and University) / COUNTRY / CURRENT COURSE
(PhD, MSc etc.)
EDUCATIONAL BACKGROUND (start from most recent history)
INSTITUTION AND LOCATION / DEGREE / YEAR CONFERRED / FIELD OF STUDY
EMPLOYMENT EXPERIENCE (start from most recent history)
POSITION HELD / DATE / EMPLOYER
SUMMARY OF PROJECT, WITH AIMS AND OBJECTIVES
(maximum 250 words)
LAY SUMMARY (maximum 150 words)
Please describe your proposed research in lay terms such that any member of the general public can understand the potential importance and relevance of your proposal. Remember not to use scientific terminology and write in plain English to aid understanding of the topic.

BACKGROUND TO THE STUDY (maximum 750 words)

Please list cited references in the section at the end of the form.
Ethical clearance number and/or status
(if required)
METHODS
Please provide full details for each question.
Where will the study be carried out? Provide details of the geographical location and why that site has been chosen.
What type of study design(s) will you use (e.g. cross-sectional, longitudinal)? Briefly explain why you have chosen each design.
What is the sample size? How has the sample size been justified? This does not require a very detailed explanation with extensive formulae if a power test has been used.
What types of data will you collect? The data will be quantitative or qualitative or a mixture of the two. Give details of main data categories, e.g. quantitative – nutritional status; qualitative – values, knowledge and experiences.
How do you intend to analyse the data? Don't just name the statistical package used (e.g. SPSS, NVivo); give details of the types of analyses to be undertaken.
What is the timeframe and schedule?

BUDGET

ITEM / DETAILS / AMOUNT (£)
Travel
Accommodation
Supplies
Others
Overall total cost of project
Total requested
Financial support from other sources requested or received

FIRST REFEREE

TITLE
(Professor/Dr/Mr/Ms) / NAME / EMAIL / ADDRESS AND TELEPHONE
Tel:
SECOND REFEREE
TITLE
(Professor/Dr/Mr/Ms) / NAME / EMAIL / ADDRESS AND TELEPHONE
Tel:
REFERENCES (maximum 1 page font size 10)