Title / First Name / Surname
Phone
SECTION TWO: CURRENT HDR SCHOLARSHIPS
Are you currently receiving any other awards or scholarships? / ☐ Yes*
☐ Pending*
☐ No
*If yes, provide the following details for award/scholarship(s):
- Name of award
- Annual monetary value
- Duration of award (commence & expiry date(s))
SECTION THREE: CURRENT HDR PROGRAM
Faculty & School
Program details / ☐PhD
☐ Research Masters / Enrolment status / ☐ Part-time
☐ Full-time
Commencement (Month/Year) / Expected completion (Month/Year)
Have you passed confirmation process? / ☐ Yes
☐ No / If yes, date of confirmation
Primary Supervisor(s) / Name:
Email:
SECTION FOUR: RHD RESEARCH PLAN (max 2 pages for this section)
Topic Area / ☐ Clinical Medicine & Science
☐ Preventative Medicine
☐ Health Behaviour Research
☐ Public Health
☐ Other:
HDR Project Title
Background
Project significance
Hypothesis/Aims
Provide a statement on how this research is translational and relevant to the field of Implementation Science
(see )
Key Objectives and Milestones
(insert rows below as required)
Objective/Milestone / Briefly describe progress to date / Expected date of completion / Will this award contribute to milestone (Y/N)?
SECTION FIVE: FUNDING REQUESTED & INDICATIVE BUDGET
Indicate which tier of award funding you are applying for:
☐ Tier One – awards of up to $5,000, available to applicants who have not received an RHD Student Award from HCRA previously.
☐ Tier Two – awards of up to $2,500, available to applicants who have been previous recipients of an RHD Student Award from HCRA.
For Tier Two applicants only –
State the outputs that have been achieved with the previous HCRA RHD/PhD Award funding that you have received:
INDICATIVE BUDGET for proposed use of award
Budget item description
(note – funds for applicant’s salary support, living expenses, or infrastructure costs are not permitted) / Estimated amount ($AU) / Are there any alternate sources of funding available to you for this item?
Indicate Y or N and describe briefly.
Total amount requested:
SECTION SIX: AWARD JUSTIFICATION
Provide a brief explanation of how you feel this award will assist you with the completion of the project outputs noted above.
Some examples to consider might include –
- Faster completion
- Dissemination of findings
- Collaborations
SECTION SEVEN: IMPACT
Provide a statement on the clinical impact and/or engagement this research will demonstrate
Maximum 200 words
Provide a summary of your project and the potential for community impact that could be easily understood by a lay audience
Maximum 200 words
Describe how consumers might be, or have been engaged in this research project
Maximum 200 words
SECTION SEVEN: APPLICATION CHECKLIST
☐ Completed application form
☐Attach copy of Research Plan (timeline) that was completed as part of the UON confirmation process, or similar
☐ Curriculum Vitae
☐Letter of support from primary supervisor
SECTION NINE: DECLARATION
(A)Applicant: By signing this application form I certify that all details given in this application are complete, correct and true. I understand that the provision of false or misleading information may result in approved funding being withdrawn and reimbursement to HCRA being required.
Applicant Name:
Signature:
Date:
(B)Research Supervisor Approval: I support the candidate’s application for consideration of a HCRA HDR Student Award.
Supervisor Name:
Title:
Signature:
Date: