Project Grant

PROJECT GRANT

APPLICATION FORM VER3.0

This application form should be used for applications to Moorfields Eye Charity under the Project Grant funding scheme.

Please use the Project Grant Guidance Notes when completing the application form. The guidance notes provide more detailed advice about what information is required in each section of the application form.

Please ensure that you complete all relevant annexes and attach the budget to the final pdf
REQUIRED FOR ALL APPLICATIONS / ANNEX A / Project grant budget (excel file)
COMPLETE WHEN APPLICABLE / ANNEX B / Collaborator Form
ANNEX C / Additional information for clinical/translational research
ANNEX D / Additional information for research involving animals
REQUIRED FOR ALL APPLICATIONS / ANNEX E / Research office approval Form

Completed applications must be submitted to the Charity Office by the published deadline via email to and contain the following:

(1) Application form (as word document)

(2) Budget sheet (Annex A) (as excel file)

(3) Scanned copy of signed Annex E (PDF/TIFF)

Section 1: Application summary Details

Q1. PRINCIPAL APPLICANT (Title / Name)
Q2. PROJECT TITLE (max 20 words)
Q3. START DATE (dd/mm/yyyy)
Q4. DURATION (months)
Q5. BUDGET SUMMARY / (a) Amount requested in this application / £
(b) Amount secured/to be secured from other source(s) / £
(c) Total Project Cost / £
(d) Will a Restricted Donation(s) be accessed for part of this funding? (delete one) / Yes / No
(e) Is this application seeking funding to supplement a currently held and active award? (delete one) / Yes / No
Q6. HOST INSTITUTION / Moorfields Eye Hospital / UCL Institute of Ophthalmology
Other – please specify
Q7. CATEGORY OF RESEARCH PROPOSED Please select one only
Pre-clinical / basic research / Translational research / proof of concept to phase IIa trials
Post phase IIa trials / Other (e.g. cross-over from pre-clinical to translational, patient welfare, healthcare services). Please provide brief details (max 50 words)
Q8. AREA OF RESEARCH PROPOSED Select area(s) (max 2) that relate to the largest theme(s) of the proposal
AMD / Corneal / ocular surface disease / Community health / rehabilitation / patient support
Diabetic retinopathy / Glaucoma / Lens / cataract
Neuro-ophthalmology / optic neuropathies / Ocular cancer / Paediatrics
Ocular inflammatory diseases / Ocular motility / visual processing
Genetics / Inherited eye disorders / Retinal / Vitreo-retinal
Q9. JOINT MEH/IoO RESEARCH STRATEGY Please select one from (a) and (b) as applicable
(a) Disease / Glaucoma / AMD / Diabetic retinopathy / Inherited eye disease / rare diseases
(b) Treatment / approach / Cell therapy / Informatics / Imaging / Gene therapy
Other (max 100 words)

Section 2: Summary of proposed research

Q1. STRATEGIC FIT AND ENHANCEMENT OF RESEARCH AND CLINICAL PRACTICE (max 150 words)
Q2. SUMMARY OF PROPOSED RESEARCH FOR SCIENTIFICALLY QUALIFIED ASSESSORS (To include key research question(s), aims & objectives - max 150 words)
Q3. SUMMARY FOR LAY READERS (max 150 words)
Q4. IMPACT STATEMENT (max 150 words)

Section 3: Related Research Grants & Applications

Q1 (DETAILS OF APPLICATIONS TO AND AWARDS FROM FUNDING BODIES WITH FINANCIAL INPUT TO THIS PROJECT.
Please include (for each application / award as relevant)
· Name of funding body
· Title of project and brief description of how the grant relates with the current application (max 100 words)
· Total value of award and value of the contribution to work related to this application
· Start/end dates / Expected date of outcome (for submitted applications)
For co / matching funding requests please also address the questions below based on type of request:
For applications that include a new, discrete, piece of research which is part of a larger funded project
· Why was this piece of research / funding requirement not presented in the original application?
· Was supplement funding requested from the original funder? If no, why not?
· Could funding be secured from another external funding body?
· What is the added value to the overall research project and to MEC in funding this additional piece of work at this time?
For applications that are requesting top-up funding to an already funded project (i.e. there are no new elements to the research proposal)
· Why was the full cost of the research project not requested within the original application (if the funding call was capped, please provide details)
· Could funding be secured from the original funding body via a different call or another external funding body? If yes, why has this not been done?
· If awarded, what, if any, element(s) of the current proposal could be attributed to MEC’s support?
· What is the added value to MEC in providing additional funding to an already funded project?
Q2 APPLICATIONS WITH NO FINANCIAL INPUT FROM OTHER FUNDING BODIES
Please provide details of how you could secure funding from a recognised charity to support this project/programme of research

Section 4: Principal APPLICANT DETAILS and CV in total section 4 must not exceed 3 sides of A4

Q1. CONTACT INFORMATION
Name and Title
Current post(s) (include employer name)
Address (department name and location)
Email address / Contact telephone number
Time spent on research (hrs per week) / Time spent on this grant (hrs per week)
Q2. PREVIOUS POSTS HELD (most recent first, maximum 5 entries)
Date from mm/yyyy / Date to mm/yyyy / Position / Organisation
Q3. EDUCATION AND TRAINING (most recent first, maximum 5 entries)
Date awarded mm/yyyy / Qualification / Subject / Organisation
Q4. GRANT APPLICATIONS TO SPECIAL TRUSTEES OR MOORFIELDS EYE CHARITY State title of project, role on the grant (e.g. PI, Co-PI), amount requested and grant application number if known.
(a) Awarded grants
Please list grants (most recent first) held in the last five years or any key prior grants.
(b) Unsuccessful applications
Please list applications in the last five years which were not awarded.
Q5. AWARDED GRANTS FROM OTHER FUNDING AGENCIES
Please list grants (most recent first) held in the last five years or any key prior grants. State name of awarding body, title of project, role on the grant (e.g. PI, Co-PI), amount awarded, and start/end dates.
Q6. PUBLICATIONS
Please list all (or key) publications from the last five years including original research publications and other scholarly contributions. Publications should be in chronological order with the most recent first. Max 1 side of A4
Q7. KEY RESEARCH/SCIENTIFIC/CLINICAL CAREER ACHIEVEMENTS
Please provide a summary of key research/scientific/clinical achievements to date that are NOT listed elsewhere in the application. Max 200 words

Section 5: Co-APPLICANT DETAILS and CV in total section 4 must not exceed 3 sides of A4 per person

Section 6: Details of Research Project

A scientific research proposal should be provided for all applications
Detail (a) hypotheses / aims of the project, (b) work which has led up to the project, (c) outline of proposed approach and how challenges would addressed, (d) Statistical analysis that will be employed / calculation of appropriate power/sample numbers for the study (e) Sustainability: outline plans for securing further / future funding to sustain this programme of work
A maximum of 3,000 words, excluding references should be used to describe the details of the project
Images/figures/schematics may be embedded in the text or submitted as part of an appendix (maximum 2 sides of A4) to this section.
References must be included – give full citation including title, journal title and list all authors (use of el al is only appropriate where there are >10 authors)
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Protocols: It is NOT appropriate to submit a full standard protocol. For epidemiology, demographic, case control cohort and related studies or any clinical trial, give a full and detailed analysis of the study design, including details of any validation already undertaken or rationale for using standard protocols. Particular attention should be given to power calculations, sample size justification and where appropriate, case definitions and inclusion/exclusion criteria.
______
For general guidance and applications for database / technology / resource development projects or supplementary / bridging support grants, applicants are advised to refer to the guidance notes

SecTion 7: Milestones, Data Management and Sharing

Q1. MILESTONES: All applications, irrespective of duration or funding level, must complete this section. However, the detail provided is expected to be proportional to the duration and level of funding.
Please include (table expandable to max 1 side of A4 OR Gantt chart (1 side of A4) attached to application)
· Research objectives, dates they should be achieved
· Possible publications (journal and submission dates), presentations / conferences, outcomes / innovations for clinical use
· Dates for recruitment of key staff, purchase of equipment etc.
Milestone (title and description) / Date (mm/yyyy)
Q2. DATA MANAGEMENT AND SHARING Where appropriate, detail (a) your plans for data management, curation and storage (b) your policy for sharing data with others, including the management and prioritisation of access to data (c) your strategy for current and future communication with user communities and (d) any ethical considerations (max 300 words)
Please refer to the guidance notes for additional advice

Section 8: Budget Details

The excel file ‘ANNEX A – PROJECT GRANT BUDGET’ must be completed and submitted with the completed grant application. Please refer to guidance notes when completing this section. All costs must be approved by an appropriate authority at MEH and UCL IoO and if necessary any other academic/clinical partner institution involved in the project.
Q1. CO-/MATCHING FUNDING COSTS. Where an application is for co-/matching funding to a grant awarded/requested from another funding body, please provide a breakdown of the funding awarded/requested. Please include budget category descriptions (e.g. salary, equipment) and value (£).
Budget category (title / description) / Amount awarded / requested

Section 9: Budget Justification all costs must be justified and described with respect to the proposed project

Q1. SALARY / STIPEND COSTS. For all posts, please include details of role, responsibilities, location and justification for level of post requested. (max 300 words)
Q2. MATERIALS AND CONSUMABLES (max 300 words)
Q3. MISCELLANEOUS COSTS. (max 200 words)
Q4. EQUIPMENT COSTS. Please provide justification for cost of equipment and any added value (to other groups) the equipment would provide (max 300 words)
Q5. ACCESS CHARGES (TO EQUIPMENT/RESOURCE/FACILITY). Please include justification for number of hours/days access requested (max 300 words)
Q6. ANIMALS. Please include justification for requested costs (max 300 words)

Section 10: Additional information

Q1. ETHICAL APPROVAL
Does this project require ethical approval (either NHS and/or Home Office)? (delete one) / Yes / No
Has this project been submitted for ethical approval (delete one) / Yes / No
If YES, by whom and when were the ethics of the project approved (include relevant reference number(s)).
If NO, by whom and when will the ethics of the project be considered
If this project is considered to be covered by existing ethical approval from a different project please confirm that new ethical approval is NOT needed (include relevant reference number(s)) and explain why existing ethical approval covers the project in this application (max 100 words)
Q2. RESEARCH INVOLVING HUMAN PARTICIPANTS AND/OR ANIMALS
Does this project involve human participants and/or biological samples? (delete one) / Yes / No
If YES, please complete ANNEX C
Will your project involve use of animals? (delete one) / Yes / No
If YES, please complete ANNEX D
Q3. INTELLECTUAL PROPERTY (IP) / COMMERCIALISATION
Will the proposed research use technology, materials or other invention that, as far as you are aware, are subject to any patents or other forms of intellectual property protection? If YES, give details (max 200 words) / Yes / No
Is the proposed research, in whole or part, subject to any agreements with commercial, academic or other organisation? If YES, give details (max 200 words) / Yes / No
Is there any potential for patents or commercially exploitable results from this research? If YES, give details (max 200 words) / Yes / No
If any potentially commercially exploitable results may be based upon tissues or samples derived from human participants, please confirm that there has been / will be appropriate informed consent for such use / Yes / No
If this research is successful will it provide added value e.g. new tools, drugs, biological materials, methods of treatment etc. that add value to eye health through a product, drug, vaccine etc. that should be protected because it will make money for the owner? If YES, please describe what this added value is (max 200 words)

Section 11: Principal Applicant Sign Off

By signing this section, the Principal Applicant, confirms that he/she have complied with the instructions for completing and submitting this application and if the application is funded he/she will agree to the terms, conditions and processes of Moorfields Eye Charity.
Q1. CONSULTANCIES, EQUITIES AND DIRECTORSHIPS
Do you have consultancies or any equity holdings in, or directorships of, companies or other organisations that might pose a conflict of interest to the current application? If YES, give details (max 100 words) / Yes / No
Q2. PRINCIPAL APPLICANT SIGN OFF DETAILS
Name (print)
Signature (electronic)
Date (dd/mm/yyyy)
Q3. EXTERNAL PEER REVIEW
(a) Proposed external peer reviewers. Please provide the names and contact details (address and email address) for 3 potential external reviewers. These must not include colleagues from your organisation or those with whom you have published/collaborated with in the last 3 years
The Charity may or may not choose to approach some, or all, of the individuals you have selected
Reviewer 1
Reviewer 2
Reviewer 3
Reviewer 4
(b) Peer review restrictions. If you do not wish the Charity to approach certain people or institutions, please provide the name / details below

ANNEX B: Collaborator Form