Research Proposal Application.Ver1

HRC REF: NI:

Full Project NgaKanohiKitea Application (FPNKK215)

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

Use the Guidelines for details on how to use this form.

This COVERSHEET is for identification purposes. It will be replaced by the online pages (Module 1, Section 1A) 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 page 2.

When completed, save this form as a pdf file before uploading to Gateway. In the pdf version of this document, Section 1B must begin on page 2.

MODULE 1: APPLICATION INFORMATION

Section 1B:

Tribal Affiliation

Iwi / Hapū
Advisors/Independent Expert and Subcontractors (include cultural, research and other)
Title / First Names / Surname / Role / Ethnic Identity
1
2
3
4

Please note that a biographical sketch will need to be provided for each person named here

IN CONFIDENCE

HRC REF: NI:

MODULE 2:PROPOSED RESEARCH

Section 2A – Description of Proposed Research

There is a 10 page limit for this section. Use the headings as appropriate.

Introduction to the health or disability issue being addressed (half a page)

Please outline the issue you intend to address in the full study (e.g. water quality, asthma in children)

Rationale for undertaking the research(half a page)

Ensure to outline why this piece of research is important to iwi/hapū or community and in what ways this is a community (whanau, hapu, iwi or other groupings) identified health need.

Proposed methodology/approach to the research[1] include the research design and methods Outline how you will address the topic and include the aims and research question(s), who are the participants? How will they be recruited? What data is needed and how will it be collected? How will the data be analysed and interpreted? How will quality of data collection and analysis be managed? Are there any key ethical issues that need to be considered?

Please note your Independent Expert may need to help you with this.

Potential gains from this research in relation to the issue/topic to be addressed
Please outline the potential gains from this research, For example what will be the gains for individuals, whānau, hapū, iwi or communities. Can the research benefit other communities, cultures or organisations wider than your own?

Involvement of community /partnerships

List the involvement and support of any other community partners (letters of support need to be attached) and demonstrate in what ways this is research is community (whanau, hapū, iwi or other groupings) driven.

Proposed team and host institution

List the names of the proposed team their roles and areas of expertise and state the nature of your expert advice, cultural competency of team members (e.g. who your expert advisors are, how will they be associated with the application and beyond, what will they be doing). Include the background story on how the research idea was generated, how and why the host institution became involved/how the partnership came about. Please note in the full application it is expected that funded positions will have names associated. Unjustified and unnamed positions may affect the assessment and or the full budget amount.

Dissemination strategy and potential for translatable results
Full details of your proposed dissemination strategy should be provided. This should include how the research involves and will appropriately disseminate results to relevant end users such as study participants, iwi, policy-makers and health service funders and providers. As well as peer reviewed publications; dissemination examples include leaflets, reports, workshops, participant newsletters, guidelines, hui and public meetings, conference presentations and mass media items as appropriate. Processes for ensuring that all information is tailored to the needs of the intended audience, so that research findings can be of maximum utility should be fully detailed.

Budget –Please download the budget sheet and fill in clearly outlining what your budget is and how it will be spent.

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MODULE 3:REFERENCES

There is no limit to the number of reference pages. Asterisks are to be placed beside applicants’ publications.

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IN CONFIDENCE

HRC REF: NI:

MODULE 4: RELEVANCE OF RESEARCH TO SPECIFIC POPULATION GROUPS

Does your research involve* any of the HRC's priority population groups?**

Māori
Pacific peoples
Children and youth
Older adults
People with disability
If no, do not complete this Module

* Leading the research or would provide a separate dataset.

** You may complete these sections if your research does not directly involve priority populations, but you can provide information that would assist the reader to understand or appreciate the scope of your application.

Section 4A

There is a 2 page limit for this section. Copy and paste subsection if it is applicable to other groups e.g. Pacific

Identify the Māori groups consulted regarding this application. Explain why and how they were selected indicate their recommendations, and whether they will have a role in the continued development and/or implementation of this research project. Append any documentation resulting from that consultation.

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Describe how this research project will build capability of the researchers towards building a highly skilled Māori Health Research Workforce.

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Describe the process used with the above groups in the development of this application, their recommendations, and if they will have a role in the further development and/or implementation of this research project, or indicate if not applicable. Append any documentation resulting from that consultation.

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Will the research generate data specific to one or more of these population groups? If so, please give details below. Describe any methodology of specific relevance to the study population.

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MODULE 5:CONTRACT INFORMATION AND BUDGET

Use the HRC Excel Spreadsheets ‘NKKbudget.xls’ for Sections 5A – 5D.

For the hardcopy of the application:

Attach a printout of the spreadsheet Sections 5A-5D (Contract Information (Objectives and Milestones), Budget, MOU Budget(s) and FTE Summary) after this page of the application form.

Ensure any page breaks are logically placed to facilitate review.

For the electronic copy of the application:

Upload the electronic file, when submitting the application Word file to the HRC Electronic Application System (EASY). Note required file name convention.

Section 5E – Justification of Expenses

Justification of research staff (as listed in budget)

Justify the role of all staff (named and un-named). These may be research assistants, technicians, medical staff, interviewers, support staff or similar, whose names or position titles are listed in the budget under “Research Staff” and who have specific FTE involvements. Un-named post-doctoral fellows should also be justified here.

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Justification of Working Expenses and Casual Staff (as listed in budget)

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Section 5F – Previous/Current contracts

List previous/current contracts (up to five). Final HRC reports may be made available to Assessing Committees.

Funding Agency::
Title of Research
Investigators
Start date and duration
Total Value
Nature of support (1 sentence)
If HRC contract, was Final Report filed? If not, why?
Funding Agency::
Title of Research
Investigators
Start date and duration
Total Value
Nature of support (1 sentence)
If HRC contract, was Final Report filed? If not, why?
Funding Agency::
Title of Research
Investigators
Start date and duration
Total Value
Nature of support (1 sentence)
If HRC contract, was Final Report filed? If not, why?
Funding Agency::
Title of Research
Investigators
Start date and duration
Total Value
Nature of support (1 sentence)
If HRC contract, was Final Report filed? If not, why?
Funding Agency::
Title of Research
Investigators
Start date and duration
Total Value
Nature of support (1 sentence)
If HRC contract, was Final Report filed? If not, why?

Section 5G – Other Support

List other research applications awaiting decision (including those to the HRC). Applicants must advise the HRC of the outcome of other research applications. Copy and paste as required for additional pending applications.

Other Research Applications Awaiting Decision:

Funding Agency
Title
Named Investigators
Start Date and Duration
Total Value
Date of Outcome
Areas of Overlap with this Application
Funding Agency
Title
Named Investigators
Start Date and Duration
Total Value
Date of Outcome
Areas of Overlap with this Application

Co-Funding: What other agencies or end-users have been approached or committed to joint or partial funding of this research?

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Section 5H –Supporting Documents Index

Please list below all memoranda of understanding (MoU) or sub-contracts and letters of collaboration.Copies of all documents should be paper-clipped separately with the original application only.

Referees and Assessing Committee members will see the list below and documents will only be made available on request.

Please note that Appendices can only be included with the permission of the HRC.

Memoranda of Understanding/Subcontracts

List below all memoranda of understanding (MoU) or sub-contracts.

Once this table has been completed, please annotate each document with the appropriate reference number from the table below (e.g. S01) and the appropriate HRC Ref ID (e.g. 10/123).Press enter on the outside of the last row to create an additional row.

MoU/subcontracts
Ref. / Organisation / Person (if applicable) / $ value (if applicable)
S 01.

Letters of Collaboration

List below letters of collaboration for this research which outline material or actual support.

Once this table has been completed, please annotate each document with the appropriate reference number (e.g. L01) and the appropriate HRC Ref ID (e.g. 10/123).Press enter on the outside of the last row to create an additional row.

Letters of collaboration
Ref. / Organisation / Person (if applicable) / $ value (if applicable)
L 01.

MODULE 6: BIOGRAPHICAL SKETCHES

Must be completed by all those names at the front of this application

Full Name
Department
Organisation
PO Box/Street number
Suburb
City and Postal Code
Telephone
Email
Iwi & hapū (if relevant)
Gender
Present Position & Current employer (if relevant)

If a Named Investigator intends to be absent for a period of longer than one month during the contract duration, please state the reason:

Period of absence / Reason
Degrees/Diplomas or Awards / University or organisation / Field / Year awarded
Honours, prizes, scholarships, etc / Year awarded
Relevant academic, community and or research experience / From year / To year

Signature

I certify that the information provided is accurate and current.

Sign: / Date:

Skills and experience relevant to this research (1 page only)

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Other forms of research dissemination (1 page only)

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Number of Publications (exclude abstracts, proceedings or letters published or presented)

List of Publications from previous five years

- List in reverse date order, starting from current year first,

- And highlight the ones most relevant to this application, by bolding the Author(s) name

- You may include citations, impact factors, and/or journal rankings.

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MODULE 7:ADMINISTRATION

Section 7A – Ethical and Regulatory Agreement

Yes / No
Requires human ethical approval?

If this application does not require ethical approval, please briefly provide reason;

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If this application requires consent from other regulatory bodies such as ERMA, MAF, DOC, GTAC, SCOTT or Biosafety, please provide reason;

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The following information will be used for administrative purposes.

Yes / No
Is the proposed research a clinical trial, a community intervention study or innovative treatment?
If yes to the above, do you intend to have an independent Data Monitoring Committee?
If yes to the above, will this be through the HRC’s Data Monitoring Core Committee (DMCC)?

Note: Information on the structure and operating guidelines of the HRC’s DMCC are available from the HRC website. For further information please contact the Secretary to the DMCC, .

The applicant has read the ‘Guidelines on Ethics in Health Research’, available from the HRC website ( and agrees to abide by the principles outlined in it. The undersigned also agrees to provide written evidence before any research procedures commence, that in any study involving animal or human subjects, animal or human materials or personal information, a properly constituted accredited Ethics committee (a list of currently accredited Ethics Committees is available on the HRC website) has examined and agreed to the ethics of the proposal outlined in this proposal. If minor changes in the research design or procedures have been required for ethical reasons, the HRC must be informed of them. The undersigned also undertakes to ensure that all regulatory consents are gained before research commences. For further information regarding the ethical approval process, please contact the Secretary to the HRC Ethics Committee, , or the appropriate accredited Ethics Committee.

Section 7B – Administrative Agreement

This Module will only be required from successful applicants offered a contract. It is provided here for reference only. No signatures are required. The full administration agreement can be downloaded from the HRC website.

All HRC applications must include an undertaking to abide by the following administrative agreement:

1.It is understood and agreed that this application and any contract awarded as a result of this application is subject to the Health Research Council of New Zealand Rules (“Permissible Use of Research Funding and Operation of Contracts”). Funds will not be expended for any other purpose than described in this application.

2.The host institution agrees and undertakes to bear all risk and claims connected with any operation covered by this application and to indemnify and hold harmless the Council against any and all liability suits, actions, demands, costs or fees on account of death, injuries to persons or property, or any other losses resulting from or connected with any act or omission performed in the course of the research.

3.The host institution agrees and undertakes to support for the duration of any contract, the work described in this application by making available accommodation, basic facilities for research and the services necessary for its fulfilment.

4.The Head of Department agrees to accept this research within his/her department if a contract is made, agrees to provide workload relief for research staff working on this contract (Principles of Full Cost Funding), and is aware that s/he may be requested by the HRC to provide a confidential assessment of the research during the term of the contract.

5.The host institution official designated below agrees to ensure that the research will have been approved, where necessary, by the appropriate institutional biosafety committee and/or all other required regulatory agencies before research is commenced.

6.The applicant(s) agrees to allow specified personal information to be used for statutory and publicity purposes.

7.The host institution has in place policies and processes to ensure that consultation with Māori has occurred and the application is responsive to the needs and diversity of Māori.

We the undersigned have read the above administrative agreement and undertake to abide by the conditions of this agreement in respect of any contract made by the Health Research Council of New Zealand as a result of this application. We the undersigned confirm that the information provided in this application is to the best of our knowledge true, that all sections are correct at the time of application submission, that each NI agrees to the stated FTE% contribution and that funding to any NI from any source will not exceed 100 FTE%.

Section 7C – Referees

Nominated impartial referee

Nominated referees are NOT references to support your application. External referees will be utilised to carry out peer review of full applications. Applicants are given the opportunity to nominate potential referees. They should NOT be people that may be compromised in their assessment of applications due to a conflict of interest such as a close professional, collegial or personal relationship with an applicant.

Maximum of two nominations.

Referee Name::

Organisation and Address
Telephone
Email
Area(s) of Expertise
Relationship to applicant(s)

Referee Name::

Organisation and Address
Telephone
Email
Area(s) of Expertise
Relationship to applicant(s)

MODULE 8:CLASSIFICATION OF RESEARCH

This module is mandatory; incomplete applications will not be processed.Do not copy any sections in MODULE 8. Send with original application only.

HRC Discipline and Fields of Research classifications are for HRC purposes only.ANZSRC information is for HRC and MoRST purposes.

Section 8A – Australian and New Zealand Standard Research Classification (ANZSRC) and HRC Classification

Applicants are required to categorise their research in two ways. The HRC Discipline and HRC Fields of Research categories are listed in Appendix 1 and 2 of the Guidelines.

The ANZSRC codes for FOR and SEO classifications can be found on the HRC weblink ( or the ANZSRC website – find the appropriate code(s) and description; insert in the table below.

Research Descriptors
HRC Discipline(see Guidelines)
HRC Fields of Research(see Guidelines)
MoRST Fields of Research (FOR)(ANZSRC code) / Weighting (%)
MoRST Socioeconomic Objective (SEO)(ANZSRC code) / Weighting (%)
Keywords

Section 8B – Mapping Categories

Tick the box () next to the category that best describes the starting point of your research: