Rangahau Hauora Award Application

HRC REF NI Surname

Rangahau Hauora Training Award Application Form (RHTA)

COVERSHEET

HRC Ref ID#:Click here to enter text.

Applicant:Click here to enter text.

Computer used to complete this form:Click here to enter PC or MAC

This COVERSHEET is for identification purposes. It will be replaced by the online pages (Module 1) in the final submitted application compiled by the HRC Gateway (

Information can only be entered into the fields indicated. Enter the details above before going to Section 1B.

IN CONFIDENCE

HRC REF NI Surname

MODULE 1: APPLICANT INFORMATION

Section 1B: Personal Information

Tribal Affiliation

Iwi / Hapū

Education history

Note: these awards are for those with limited academic qualifications/research experience

Educational experience / Year / Institution

Relevant employment experience

(List in chronological order with most recent first;do not attach continuation pages)

Position / From (year) / To (year) / Organisation
Describe any research experience you have (if any)
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IN CONFIDENCE

HRC REF NI Surname

MODULE 2: RESEARCH TRAINING INFORMATION

Section 2A: Overview of Research Training

Name of training course (e.g. methodology paper, statistics) or type of research to be undertaken (e.g. interviewing, data analysis)
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Host Institution - who will administer the award
Research Training Location(s)
Telephone
Email

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HRC REF NI Surname

Section 2B: Research Training Details

(2-page maximum)

Describe the proposed research training programme using the following headings as a guide.

Outline the aimsof the training and what is hoped to be achieved
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Provide rationale of thesignificance of the research planned or training courses to be undertaken
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Describe the present or future relevance of the research training to improving Maori health
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Outline your Māori community involvement
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What research skills relevant to this topic do you wish to learn?
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Describe how you intend to apply these skills in the future

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IN CONFIDENCE

HRC REF NI Surname

MODULE 3: REFERENCES(1-page maximum)

Asterisks are to be placed beside applicants’ publications. Provide references in full and state full authorship (for example not Smith et al). Endnote lists must be copied into a plain text editor before pasting in here.

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HRC REF NI Surname

MODULE 4: BUDGET AND CONTRACT INFORMATION

Section 4A: Contract Information

Outline costs associated with your study

Item / Cost
Total

Budget Justification

Provide justification why the costs listed above are necessary to fulfil the proposed training programme. State how you have determined these amounts and provide quotes where applicable.

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Section 4B – Letters of Collaboration/Supporting Documents List

List below all MOU or sub-contracts and include copies with the application. All other documents should be paper-clipped separately with the application and should include the HRC Reference ID#. Letters of collaboration, which outline material or actual support, can also be listed. Science Assessing Committee members will see the list below and documents will only be made available on request.

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IN CONFIDENCE

HRC REF NI Surname

MODULE 5: NZ STANDARD CV – Supervisor

Section 5A: Supervisor

PART 1

1a. Personal details of Supervisor
Full name / Title / First name / Second name(s) / Family name
Present position
Organisation/Employer
Contact Address
Postcode
Work telephone / Mobile
Email
Personal website (if applicable)
1b. Academic qualifications