Scientific Office, PO Box 8219, CH-3001 Bern, phone +41 (0)31 389 91 16, fax +41 (0)31 389 91 62
Delivery address (parcels): Effingerstrasse 40, CH-3001 Bern, ,

Application for Research Funding

Deadline for submission: 30 septembre

1PROJECT

1.1Project type

New project
Continuation / of project number
Revised version / of project number / Please provide point-to-point reply.

1.2Title in English (1-3 lines) AND title in German or French (1-3 lines)

1.3Keywords (5-8)

1.4Funding required

/ total from section 7 / CHF

1.5Start date

/ duration (months)

1.6Is there likely to be a follow-up project?

/ Yes / No

1.7Principal applicant

Last name

/

First name

Nationality

/

Languages

Academic title

/

Date of birth

Work address

Phone number (work)

/

Secretary

Email

/

Fax

Home address

Phone number (home)

1.7.1Co-applicant 1

Last name

/

First name

Nationality

/

Languages

Academic title

/

Date of birth

Work address

Phone numbers (work)

/

Secretary

Email

/

Fax

Home address

Phone number (home)

1.7.2Co-applicant 2

Last name

/

First name

Nationality

/

Languages

Academic title

/

Date of birth

Work address

Phone numbers (work)

/

Secretary

Email

/

Fax

Home address

Phone number (home)

1.7.3Co-applicant 3

Last name

/

First name

Nationality

/

Languages

Academic title

/

Date of birth

Work address

Phone numbers (work)

/

Secretary

Email

/

Fax

Home address

Phone number (home)

1.7.4Co-applicant 4

Last name

/

First name

Nationality

/

Languages

Academic title

/

Date of birth

Work address

Phone numbers (work)

/

Secretary

Email

/

Fax

Home address

Phone number (home)

1.7.5Co-applicant 5

Last name

/

First name

Nationality

/

Languages

Academic title

/

Date of birth

Work address

Phone numbers (work)

/

Secretary

Email

/

Fax

Home address

Phone number (home)

1.8Reviewers

1.8.1External Reviewers – Exclusion

If you wish to exclude certain reviewers from the evaluation process, please provide their exact names and work affiliations below:

1.8.2External Reviewers – Recommendation

If you have any suggestions for external reviewers, please provide their exact names and work affiliations below:

1.9ClassificationPlease classify by placing an X below.

Basic research

Clinical – laboratory oriented research

Clinical – patient oriented research

Psychosocial research

Epidemiological research

Other domains (please specify)

1.10Lay Abstract

Please provide a lay abstract of your research project in German or French (500-1’000 characters, including space) ) for probable future use in fund raising activities for cancer research. If your research is financed, this abstract will be published in the report “Cancer Research in Switzerland” from the Swiss Cancer League.

1.11Lay Abstract

Please provide a lay abstract of your research project in English (500-1’000 characters including space). If your research is financed, this abstract will be published in the report “Cancer Research in Switzerland” from the Swiss Cancer League.

2SCIENTIFIC DETAILS

2.1Summary of the research plan (max. 1 page)

2.1.1Address of the ethics committee that will be evaluating this application:

2.1.2Mandatory for clinical research applications only!Please note the name of the registry where this study is or will be registered:

2.2Research planThis research plan should cover the following points:

2.2.1Brief description of the current status of research in the field in which the work is planned, giving the titles of the most important relevant studies by other authors.

2.2.2Brief description of the status of the applicant's own research in the field in which the work is planned, giving the titles of the most important relevant studies.

2.2.3Detailed research plan

2.2.4Time-frame for the overall project: Which research activities are scheduled to be carried out during the period for which funding has been requested?

2.2.5What, in your opinion, is the significance of the planned work?

2.2.6How is the project under consideration connected to work you are carrying out which is being funded by other bodies (e.g. university, Swiss National Foundation for Scientific Research, cantonal cancer leagues)?

If the research project comprises several individual projects, scientific details must be supplied separately for each of them (A, B, C). In this case the applicant should state which scientists will be involved in each individual project and who will be the scientific project manager in each case.

3AVAILABLE RESOURCES

What level of total funding is currently available to you; how much of this total can you use for the project under consideration (not including the funding requested in this application)?

The following details must be supplied:

3.1Personnel

3.2Existing equipment

3.3Funding required for new equipment, consumables, travelling and other expenses

3.4Infrastructure (rooms, workshops, computer centeres, libraries, etc.)

4FUNDING REQUESTED FROM OTHER SOURCES

4.1Funding granted from other sources (amounts, sponsors)

4.2Applications for financial assistance have also been / will be submitted to the following organizations:

5LEVEL OF FUNDING REQUIRED

What funding will be required during the period of credit? If several projects are included in the same application, an individual budget should be given for each project separately where possible.

5.1Consumables (as well as maintenance and hire of apparatus)Grouped according to apparatus or system

/

in CHF

5.2Miscellaneousexpenditures(only exceptionally and if well-documented)

E.g.: material of lasting value, field expenses, travelling, congresses, etc. (justify individually)

Total in CHF

6PERSONNEL REQUIREMENTS

6.1Salaries

Last Name / Nationality / Academic title or diploma / Function / Salary group / Gross salary paid by other sources in CHF
1st year / Gross salary paid by SCL/CRS in CHF
1st year
First name / Marital status / since (mmm/yy) / % of working time / from / 2nd year / 2nd year
Swiss social security No. (where appropriate date of birth) / Number of children / Doctoral candidate: no/yes, since / Salary from SCL/CRS since (mmm/yy) / 3rd year / 3rd year
1.
please selectyesno
2.
please selectyesno
3.
please selectyesno
4.
please selectyesno
5.
please selectyesno
6.
please selectyesno
7.
please selectyesno
Total in CHF
Summary of salaries
Number of positions / Subtotal in CHF / Total in CHF
Academics
Doctoral candidates
Technical staff
Administrative staff and assistants
Total in CHF

6.26.2

/

Social security contributions (employer contributions; see information sheet on social security contributions)

Total in CHF

7SUMMARY

Project A / Project B / Project C / Not assignable to a specific project / Total
5.1 / Consumables
5.2 / Miscellaneous expenses
6.1 / Salaries
6.2 / Social security contributions
Total in CHF

8SIGNATURES & ENCLOSURES

Please confirm by marking the box below:

The institution (organisation, university, hospital, study group etc.) where the project will be carried out, is not active in the field of direct mailing.

Principal applicant

Place, date

/ , /

Signature

Co-applicant 1

Place, date

/ , /

Signature

Enclosures

Curricula vitae of the applicants
List of publications by the applicants
Publications / quantity
Offers / Estimates received / quantity

9ADDITIONAL PAGE

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