/ Research grant application form
Please email completed form and attachments to by the advised deadline for the grant round you are applying for. If you have not received an acknowledgement within three working days, please contact 0116 252 5858
/ CCLG 40th anniversary research grants

PART ONE: APPLICATION DETAILS

  1. Title of the study:

  1. Applicants

Applicant 1
(Lead applicant) / Applicant 2 / Applicant 3
Title
Surname
Forename
Post held
Institution
Number of hours per week expected on project

If there are more than three applicants, please attach an additional page

  1. Institution that would be administering the grant

Name
Address at which work will be undertaken
  1. Proposed timetable

Start date: / Duration (months):
  1. Please indicate broad area of grant sought

Basic/fundamental science / Translational science / Clinical science / Other
  1. Total grant requested

£
  1. Summary of requested support (full details to be given in part 3)

Year 1 / Year 2 / Year 3 / Total
Staff
PhD Studentships
Consumables
Travel & subsistence
Exceptional items
Equipment
Total
  1. Does the project require ethical approval for working with human subjects?

If yes, please attach, or indicate when this is likely to be granted. An award will not activate until ethical approval is confirmed in writing

No / Yes, approved and attached
Yes, approval pending / If pending, date expected:
  1. Are animal studies involved?

No / Yes
If yes, please briefly describe the nature of the involvement and the status of any project licence holder procedure in relation to this application:
Please describe how you have considered the replacement, refinement and reduction of animal use in research (3Rs)?
  1. Other sources of funding
  1. Has earlier research relevant to this study by your or your team been externally funded?

No / Yes

If yes, please give details:

Topic
Supporting organisation
Value of grant(s)
Start date and duration of grant(s)
  1. Is this application or a related application being submitted elsewhere?

No / Yes

If yes, please give details:

To which organisation?
When is a decision anticipated?
  1. Has this application been submitted elsewhere during the last 12 months?

No / Yes

If yes, please give details:

To which organisation?
What was the result of the application?
  1. Is funding (or other resources e.g. staff time) required from other sources for the successful completion of this project?

No / Yes

If yes, please give details:

Source of funding/resources
Duration of funding/resources
Has this funding been awarded?
Details of how the funding/resources will be used on this project
  1. Exploitation

Is the proposed research likely to lead to any intellectual property which may be commercially exploited (eg via a patent)?

No / Yes

If yes, please give brief details:

The nature of the intellectual property
The nature of the mechanism(s) used to determine whether registration is required
The name and post of the official responsible for registering any intellectual property
  1. External reviewers

CCLG is happy for applicants to suggest external peer reviewers, but these should not be collaborators or researchers with whom you have published in the last five years. If you would like to suggest appropriate external reviewers, please do so below. CCLG reserves the right to select our own external reviewers.

Name / Institution / Position held / Email address (if known)

You may also provide the names of researchers you who you would prefer did not see the proposal. This should not be all the researchers in your field, and you will need to provide a reason why any particular individual should not be consulted:

  1. Lay summary

Please give a brief (300 words max)plain English summary of the proposal, its methods, outcomes and/or deliverables. Please note this summary may be used to screen your application before deciding to advance your application or by potential peer reviews to decide if they can review your application. CCLG also reserves the right to publish this summary in the public domain to demonstrate our research funding to our supporters. Therefore please do not include any confidential or commercially sensitive information.

  1. Institutional approval

The application should be approved by the Head of Department and by the administrative or finance officer who will be responsible for administering any grant which may be awarded.

Declaration

I confirm that I have read this application and that if a grant is awarded the work will be accommodated and administered in our institution. The staff gradings and salaried quoted in the application are correct and are submitted in accordance with the normal practice of this institution.

Head of Department

Name / Title
Institution / Telephone
Email
Signed / Date

Financial/Administrative Officer

Name / Title
Institution / Telephone
Email
Signed / Date

The electronic version of this application can be submitted giving names and date of ‘signature’ by authorised officers. A printed and signed page should be forwarded ASAP to CCLG by post. Please indicate clearly to which application it belongs:

For printed, signed version:

Title of study:
Lead investigator name:

Post to:

Research Administrator

Children’s Cancer and Leukaemia Group

University of Leicester

Clinical Sciences Building

Leicester Royal Infirmary

Leicester LE2 7LX

  1. Applicant contact details

Applicant 1

Name / Title
Post
Department
Institution
Address including
postcode / Tel
Email

Applicant 2

Name / Title
Post
Department
Institution
Address including
postcode / Tel
Email

Applicant 3

Name / Title
Post
Department
Institution
Address including
postcode / Tel
Email
  1. Collaborators

Please give details of collaborators on whom the viability of the project is dependent. Include a statement (letter/email) of willingness to act as collaborator from each person named below.

Collaborator 1

Name / Title
Post
Department
Institution
Address including
postcode / Tel
Email

Collaborator 2

Name / Title
Post
Department
Institution
Address including
postcode / Tel
Email

Collaborator 3

Name / Title
Post
Department
Institution
Address including
postcode / Tel
Email

Continue on a separate sheet if necessary.

PART TWO: THE PROPOSED RESEARCH STUDY

Give a full description of the proposed study (not more than five pages). This account should use the following headings:

  • Title of the study
  • Academic abstract
  • Purpose of the research
  • Background/rationale
  • Indications of where patient benefit will accrue
  • Plan of investigation and methods to be employed
  • Detailed justification for the support requested
  • Plans for dissemination

This should be attached as a separate document when parts one and three of the application are submitted.

Please confirm file name attached:

PART THREE: DETAILS OF SUPPORT REQUESTED

You can apply for funding for staff, consumables and equipment. As a charity, we only fund the direct costs of research. We do not fund infrastructure costs or indirect costs. Salaries for applicants are not funded.

  1. Staff to be engaged in the project

Staff / Grade / Start point on scale / Increment date / Starting salary / Allowances / Superannuation and NI
Research staff / 1
2
3
Technical staff / 1
2
3
Clinical staff / 1
2
3
Other staff / 1
2
3
  1. Proposed annual cost to project of above posts

% of time / Months on project / Year 1 cost / Year 2 cost / Year 3 cost / Total cost
Research staff / 1
2
3
TOTAL COST RESEARCH STAFF:
Technical staff / 1
2
3
TOTAL COST TECHNICAL STAFF:
Clinical staff / 1
2
3
TOTAL COST CLINICAL STAFF:
Other staff / 1
2
3
TOTAL COST OTHER STAFF
TOTALS CARRIED TO PART 1 SECTION 7 / Year 1 staff costs / Year 2 staff costs / Year 3 staff costs / Total staff costs
  1. Cost of PhD studentships (if applicable)

Year 1 cost / Year 2 cost / Year 3 cost / Total costs
Fees
Stipend
Other
TOTALS CARRIED TO PART 1 SECTION 7
  1. Costs of consumables specific to the project

Item(s) / Year 1 cost / Year 2 cost / Year 3 cost / Total costs
TOTALS CARRIED TO PART 1 SECTION 7
  1. Travel and subsistence

Conference attendance expenses can be included for dissemination/presentation of project results but not for general education purposes for the individual

Destination/reason for journey / Number of journeys / Travel / Subsistence / Other costs / Total
Year 1 / Year 2 / Year 3 / Total
TOTALS CARRIED TO PART 1 SECTION 7
  1. Exceptional items and one-off expenditure

Item(s) / Year 1 cost / Year 2 cost / Year 3 cost / Total costs
TOTALS CARRIED TO PART 1 SECTION 7
  1. Equipment

It is expected that equipment is project-specific and that formal quotes will have been received from suppliers

Equipment / Expiry date of quote / Expected delivery date / Basic price / Duties/fees / VAT
ESTIMATED TOTALS CARRIED TO PART 1 SECTION 7 / Year 1 / Year 2 / Year 3 / Total

PART FOUR: CURICULUM VITAES

Please provide a professional and publications CV for all applicants. Max 2 pages per individual.

These should be compiled into ONE document and attached as a separate document when parts one and three of the application are submitted.

Please confirm file name attached:

SECTION FIVE: CHECKLIST

Parts one and three (this form) completed and attached
Part two (proposed research study) completed and attached
Part four (curriculmvitaes) completed and attached
Statement(s) of support from all collaborators named at part one, section 7 attached
Above documentation emailed to
Signed copy of part one, section 14 (declaration) sent by post