APPLICATION FORM:

RCEM/NIHR YOUNG INVESTIGATOR OF THE YEAR, 2017-8

Title: Dr / Surname: Click here to enter text. / Forename: Click here to enter text.
CONTACT INFORMATION
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GMC Number: / Click here to enter text.
RCEM Membership Number: / Click here to enter text.
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CURRENT EMPLOYMENT
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Start date of current employment: / Click here to enter a date. /
CCT date / Click here to enter a date. /
QUALIFICATIONS: Degrees and Diplomas
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RESEARCH EXPERIENCE
Please give an account of your experience in research relevant to Emergency Medicine to date (maximum 3,000 characters)
ARRANGEMENTS FOR MENTORSHIP
Please describe the arrangements for mentorship if your application is successful
(maximum 2,000 characters)

CASE FOR SUPPORT

SUMMARY OF THE PROPOSED RESEARCH
Please provide a structured abstract of the proposed research
(maximum 2,000 characters)
BACKGROUND TO THE PROPOSED RESEARCH
Please describe the background to your proposed research, including why it is important
(maximum 2,000 characters)
OBJECTIVES
Please describe the objectives of the proposed research
(maximum 500 characters)
METHODS
Please provide a structured account of the proposed methodology
(maximum 5,000 characters)
DISSEMINATION AND IMPACT
Please describe your plans for disseminating your findings and the expected impact of this work
(maximum 1,500 characters)
FUNDING
Please provide details of all funding requested (maximum £5,000) and its justification
(maximum 300 words)
Item / Amount (£) / Justification

Please submit your completed form to Holly Lyons at