The Judith Marsham Farrell Research Grant
APPLICATION FORM
Closing date for nomination is 10 November 2017
Lead applicant details
Name / Click here to enter text. /Address / Click here to enter text. /
Email address / Click here to enter text. /
Occupational Therapy Australia member number / Click here to enter text. /
Project details
1. Title of project(no more than 25 words)
Click here to enter text.2. Aims of project(no more than 100 words)
(Clearly state the research question and aims of the project)
3. Research design and methodology(no more than 400 words)
(Include a clear description of the project design, participants, inclusion/exclusion criteria, procedures, proposed recruitment and data collection methods, and data analysis.)
4. How does the project align with the purpose of the Judith Marsham Farrell Award intentions? (no more than 100 words)
Click here to enter text.5. Significance of the project (no more than 100 words)
(Explain the significance of the project to occupational therapy and how the project contributes to the research capacity and career development of the lead applicant)
6. Is this study part of a project for a tertiary qualification? (Check one box below)
Yes☐No☐
If yes, please state the qualification, the university, when enrolment commenced and whether full or part time:
7. Has ethical approval for this project been obtained/applied for?
Yes☐(Please provide written evidence if ethical approval already obtained. If this application is successful and ethical approval is yet to be obtained, confirmation must be provided before funds will be released.)
No☐
N/A☐(Please provide brief explanation)
8. Proposed use of funds(no more than ½ page)
Provide an itemised budget, with a brief (up to 2 lines) justification for each item, in the table below listing how grant funds will be used. This may include salaries, purchase of materials or equipment, other consumables, or travel-related costs (related to data collection; conference travel will not be supported by this award). In 2017, the amount expected to be available for this award will be around $5,000.
Budget item / Brief explanation and justification / Estimated amount ($)Salaries/personnel / Click here to enter text.
Materials/equipment / Click here to enter text.
Consumables / Click here to enter text.
Travel (e.g. related to data collection) / Click here to enter text.
Other / Click here to enter text.
9. Brief Curriculum Vitae of Lead Applicant (no more than 1 page)
Academic Qualification / Qualification / Year Awarded / UniversityClick here to enter text. / Click here to enter text. / Click here to enter text.
Click here to enter text. / Click here to enter text. / Click here to enter text.
Click here to enter text. / Click here to enter text. / Click here to enter text.
Current position / Click here to enter text.
Previous research grants
(If any, list project title, amount awarded, and funding body)
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Publications
(If any, list five most recent)
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Conference Presentations and Posters
(If any, list up to five most relevant conference presentations and posters)
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Awards and Prizes
(If any, list up to 3 most relevant awards and prizes)
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Eligibility criteria
Criteria / Evidence / Office reviewLead applicant must be an AHPRA-registered occupational therapist / List AHPRA Registration Number
Click here to enter text.
Qualification of Lead Applicant
PhD
OR
If applicant does not have a PhD, a signed letter of support must be provided from an AHPRA registered OT experienced researcher (doctorate or equivalent with evidence of scholarly publications in the past 5 years) who agrees to mentor the applicant for the project and monitor compliance with Human Research Ethics Committee approvals and requirements. / Provide copy of PhD Award OR Letter of Support
Membership of Occupational Therapy Australia at least 24 months (i.e. since June 2014)
Australian citizen or permanent resident / Provided copy of Passport photo page or evidence of permanent residency
If ethics approval already obtained, approval from a Human Research Ethics Committee in Australia. Evidence must include:
A list including the lead applicant and the names and affiliations of all associate investigators. / Provide copy of ethics approval letter
All applications will be reviewed by the OTA Research Foundation Committee.
Selection timeframe
Nominations close: Friday 10 November 2017
Decision and announcement: November-December 2017
Application checklist
Completed application form☐
All evidence to support eligibility criteria is supplied ☐
Please forward your application with attachments to:
EA toRachel Norris, CEO