QUESTIONNAIRE Training Fellowship

ERS Headquarters, 4 Avenue Sainte-Luce, CH-1003 Lausanne, Switzerland

Tel +41 21 213 01 01 E-mail

Subject: RESPIRE2 (2ndround) / 12-month interim report

Dear RESPIRE2 Fellow,

You are approaching or have reached the end of the 2nd interim period (12 months) of your 2-year fellowship. As part of the requirements set out by the ERS and EU as well as in line with the 2014 Performance Obligations & Regulations**, the mandatory interim reports and related documents will be due at the latest ONE month following the end of the 12-month period.

We therefore kindly ask fellows to:

Fill out and sign the confidential questionnaire hereunder with reference to the first 12 months of your fellowship, including the ethics checklist and confirmations section.
Enclose a 1 or 2-page separatesummary report on progress towards your fellowship research project, also covering ethics as well as career development. Kindly inform us if any information should be kept confidential.
Enclose a copy of all ethics official approval(s) for the research project provided by the local ethical review board (and any other relevant bodies as necessary) for this period, if and as needed. If several approvals were needed for different types of research, please include copies of all of them. This is a mandatory requirement, linked with the programme’s EU co-funding, as per 2014 Performance Obligations & Regulations (section F). Please also refer to the Ethics checklist hereunder.
Ensure that your Host Supervisor has received the enclosed Host report and returned it directly to ERS at: . This will be kept confidential.
Please feel free to enclose any other additional, relevant information (e.g. copy of training and career development outline plan, copies of publications etc).We kindly remind you that – in light of EU requirements, copies of any publications linked to the fellowship should be provided to ERS.

Upon receipt of the above mentioned documents, the ERS office will aim to come back to you with any queries or missing/incomplete documents within 2-3 weeks. If all the needed documents have been submitted and have been accepted, the ERS office will then proceed with transferring the 3rd instalment of the grant to the fellow or Host centre. The payment will be sent to the same Bank account used for the 1stand2nd instalments (bank form) unless the fellow informs us of any changes.

It is the responsibility of the fellows to ensure all the above documents (incl. Host report) are timely submitted and fully complete, to guarantee swift transfer of the payment.

Based on reports received, ERS may provide specific feedback (e.g. independent ethics review, etc) at any time during the fellowship. Mentors will also get a copy of interim and final reports (please refer to Mentor/Mentee agreement)

Thanking you for your cooperation and remaining available for any queries or further assistance,

ERS Scientific Activities

**As a reference, the 2014 Performance Obligations & Regulations are available at:

INTERIM QUESTIONNAIRE– FELLOW

ERS/EU RESPIRE2 Fellowship programme

To be completed by the Fellow.Should you need extra space, please extend relevant fields or attach extra sheets.

Where several options are available, please highlight the relevant one.

FELLOW FULL NAME:

FELLOWSHIP NUMBER:RESPIRE2 – 2014 - xxxx

HEAD OF RESEARCH:

ADDRESS OF HOST UNIT:

DATE OF THE FELLOWSHIP:

TITLE OF THE RESEARCH PROJECT:

Your living and mobility allowance:

- is sufficient to cover living/mobility expenses in the work location? Yes No  (explain)

- is subject to tax and/or social security deductions?Yes No  (explain)

……………………………………………………………………………………………………………..

2.What is the principal objective of your fellowship?

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3.Have you been able to follow the timeline for your project as set out in your application file? How are you planning for potential risks/challenges to ensure that you deliver the research on time?

……………………………………………………………………………………………………………..

Please comment on the expected final results and their potential impact/use (e.g. socio-economic impact, wider societal implications).

Also, is there anything from your work to date that would have an impact on the public or patients? If so please give details, as this can be promoted by the European Lung Foundation (ELF;

……………………………………………………………………………………………………………..

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5.How often do you attend activities organised by or receive support from your Host department/supervisor?

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6.a)Where appropriate, rate the following aspects of your Host institution:

(use a scale of:5 – Excellent; 4 – Very Good; 3 – Good; 2 – Average; 1 – Poor)

Welcome & admin (work/residence permit, work contract, social security, taxation, language issues, administrative mentor support, etc..) / 5 / 4 / 3 / 2 / 1
Your integration within the work group and assistance from your colleagues / 5 / 4 / 3 / 2 / 1
Assistance from your host supervisor and scientific mentor (in terms of frequencyand quality) / 5 / 4 / 3 / 2 / 1
Support regarding ethical requirements and IPR / 5 / 4 / 3 / 2 / 1
Host’s suitability with regard to your proposed project / 5 / 4 / 3 / 2 / 1
Opportunities to train and/or supervise students/other researchers as well as to develop scientific and non-scientific skills / 5 / 4 / 3 / 2 / 1
Career development support(e.g. training & career outline plan, career advice/HR office, workshops, performance assessment, mentoring/coaching etc) / 5 / 4 / 3 / 2 / 1
Cooperation with other researchers in partner institutions in the same country and beyond / 5 / 4 / 3 / 2 / 1
Availability & adequacy of equipment (e.g. computing facilities, office/laboratory space, equipment, sources of information, health & safety, medical library etc.) / 5 / 4 / 3 / 2 / 1
Support towards research project (e.g. research cost contribution, lab technician, IT support, etc) / 5 / 4 / 3 / 2 / 1

b) Do you have any other comments regarding your Host institution where the ERS office could potentially help?

Would you recommend this institution to others wishing to undertake a similar fellowship (if not, why not?).

Please note that your reply will remain confidential.

……………………………………………………………………………………………………………..

Please refer to section C of the 2014 Performance Obligations & Regulations and provide a summary with regard to the training & career development outline plan (goals identified & their implementation) that you developed in cooperation with the Host.

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8.As part of EU/ERS reporting requirements, briefly explain how you are using the travel & mobility allowance and list in a comprehensive manner all career development as well as dissemination activities undertaken so far (e.g. publications, patents submitted, presentation/talks, attendance at Congresses, articles published in the press, awards received, websites, press releases)

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Is the fellowship contributing to improving your scientific and non-scientific skills as a researcher? If yes, please explain how (e.g. independent thinking, communication of scientific results, problem solving, group leader skills, etc.)

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Is the fellowship providing you with new research and/or professional contacts?

Are new collaborations being created as part of the fellowship (e.g. Home/Host, etc)?

Yes  No 

if yes, indicate in each case: e.g. universities, research centres, industry, other

……………………………………………………………………………………………………………..

Please briefly list below when you have been in contact with your ERS appointed external mentor as well as by what means (e.g. phone, face-to-face) and provide your feedback so far on the pilot mentoring scheme.

……………………………………………………………………………………………………………..

12.Do you expect the mobility aspects of this fellowshipto increase your chances of employment post-fellowship? Yes  No  Not relevant 

Please rate your overall degree of satisfaction with the fellowship programme so far and provide any further comments/suggestions you would like to share with ERS and/or highlight potential areas of support.

(use a scale of 5 – Excellent; 4 – Very Good; 3 – Good; 2 – Average; 1 – Poor)

……………………………………………………………………………………………………………..

Ethics EU checklist (please select the relevant answer)

a) Did the work performed in the past 6months of this fellowship involve any of the following?

Informed consent - Yes/No
Human embryonic stem cells - Yes/No
Privacy and data protection - Yes/No
Use of human biological samples and data - Yes/No
Research on animals - Yes/No
Research in developing countries - Yes/No
Dual use - Yes/No

b) Where the answer was ‘Yes’ to any of the categories above, please enclose documented proof that the work performed in the past 6 months of this fellowship had all necessary local ethical review board approval(s). In principle, all projects should have received approvals from local ethics board (see: 2014 Performance Obligations & Regulations - section F)
c) Will work performed in the next 6 months of this fellowship involve any of the following?

Informed consent - Yes/No
Human embryonic stem cells - Yes/No
Privacy and data protection - Yes/No
Use of human biological samples and data - Yes/No
Research on animals - Yes/No
Research in developing countries - Yes/No
Dual use - Yes/No

d) Where the answer was ‘Yes’ to any of the categories above, please enclose documented proof that the work performed in the next 6 months of this fellowship has all necessary local ethical review board approval(s). In principle, all projects should have received approvals from local ethics board (see: 2014 Performance Obligations & Regulations - section F)
e) Do you wish to raise any concerns/comments regarding ethics compliance to the ERS at this stage? Yes/No

Confirmation (please tick relevant boxes)

Through this questionnaire, the fellow also confirms the following:

☐I continue to consult and comply with ERS/EU regulations, as set out in the 2014 Performance Obligations & Regulations.

☐There is no double funding as defined in section E.ii of 2014 Performance Obligations Regulations and, should any double funding arise, this will be declared at any time.

☐The research continues to be in compliance with all fundamental ethical standards and principles at EU level, including PF7, and national level legislation/guidelines, as per section F of the 2014 Performance Obligations & Regulations.

☐I have received either directly or via the Host, the RESPIRE2 grant (2ndinstalment), equivalent to the corresponding amount out of the total grant (€64’600 per fellow-year x 2 years), as per section E of the 2014 Performance Obligations & Regulations and including the travel & mobility allowance.

☐The Host centre has been providing the contribution towards research costs (corresponding amount from total of €20,000 per fellow-year x 2 years), as per section C of the 2014 Performance Obligations & Regulations.

☐There are no administrative changes as well as any event or circumstances which might affect the implementation of the fellowship or are likely to have an impact on the performance of the fellowship, as per section D of the 2014 Performance Obligations & Regulations.

☐I have informed or will inform ERS of any scientific publications and submission of patent applications arising from the fellowship research, within two months at the latest. I am aware of requirements in terms of acknowledgement of support and publicity (e.g. ERS; EU), as per section D of the 2014 Performance Obligations & Regulations.

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I certify that I have carefully read and I am responsible for all the answers provided above. I certify that my answers to the foregoing statements are true and complete to the best of my knowledge.

Place & Date: ______(dd/mm/yyyy)

Fellow signature: ______