PARTNERSHIP STRENGTHENING WORKSHOP – PROGRAMME AND PARTNERSHIP CONCEPT FORM

Please fill out the form below with as much detail as possible. The more detail we have, the easier it will be for us to assess the applications and tailor the workshops for your needs. There is space for up to four partnership groups per workshop.

Please provide the contacts of those who would attend the workshop and sign the form to state that you will be submitting an Expression of Interest for R2HC funding.

TIMINGS

  • The deadline for submission of this application is 17.00 GMT Monday 27th April 2015
  • We will notify applicants of success no later than Friday 8th May 2015
  • The workshops will be held during the last two weeks of June 2015

ABOUT YOUR COLLABORATION / PROGRAMME
AIMS AND OBJECTIVES
Planned Research Question / Programme
Thematic health area
Geographical focus(R2HC encourages multi-country comparative studies where appropriate)
Why have you brought this group of people together?
How will the members of your team contribute to the research programme?
How will your research contribute to improving Humanitarian outcomes
STAGE OF PARTNERSHIP
What stage is your partnership? (tick) / In contact about the programme/idea but never met face to face □;
Somepartners established, but new ones brought in for this programme □;
Extension of previous programme but new geographic/thematic areas □;
Idea / Research question established but partnership needs strengthening □;
Partnership established but Research question needs further work □;
SIGNIFICANT CHALLENGES FOR THE PARTNERSHIP AND PROGRAMME DEVELOPMENT (Please see for some of the challenges ELRHA has identified)
ASPECTS OF YOUR PARTNERSHIP / PROGRAMMEREQUIRING SUPPORT
FURTHER INFORMATION – Please provide any other relevant information that you feel will add to your application
CONTACT INFORMATION OF LEAD APPLICANT AND PARTNERS (Please provide a one page summary CV for each partner – no more than one page will be considered. A template can be downloaded from
Full Name
Job Title
Organisation
Contact Address
Nationality
Country of work
Email
PARTNER 1
Full Name
Organisation
Job title
Nationality
Country of work
Email
PARTNER 2
Full Name
Organisation
Job title
Nationality
Country of work
Email
PARTNER 3
Full Name
Organisation
Job title
Nationality
Country of work
Email

PREFERRED WORKSHOP VENUE (please select either the closest location or the one that will be the least expensive for all your partners to meet)

Workshop location / Select in order of preference (1 – 4)
Dubai
Bangkok
Accra
Johannesburg

We understand that if we are selected to participate in the workshops, that we will be required to submit an Expression of Interest to the R2HC. We also understand that participation in these workshops is NOT a guarantee of funding.

Signed: …………………………………………………………………….Date: …………………..…………………………………….

Name: ……………………………………………………………………..Job Title: …………………………………………………….

Organisation: ………………………………………………………………………………………………………………………………………

Please email the completed forms back to:

Frances Hill, Effective Partnerships Manager, ELRHA

*Please visit DAC list for details of which countries qualify for travel subsidies

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