This Fully Completed, Two-Page Form Must Be Used to Inform the University and NHS Trust(S)

This Fully Completed, Two-Page Form Must Be Used to Inform the University and NHS Trust(S)

This three-page form must be fully completed and used to inform The University and NHS Trust(s) of all research, whether internally or externally funded. It must be signed by:

  • An R&D Office on behalf of the NHS Trust where staff are to be based and resources/facilities will be used[1].
  • ALL the Heads of Departments or an Authorised Signatory of each University Department or Division/ School to receive financial credit from such an award. The Faculty of Medical and Human Sciences Research Office will be unable to authorise any proposal in the absence of an appropriately completed Notification Form.

For help with information required in each field, click on relevant field and press F1 or refer to the guidance notes.

1) Project Details

Full Title of the Project:
Please use the same title as used in ethics application form.
Sponsor of Project: / Please chooseCMMC TrustChristie Hospital TrustSalford Royal Hospitals TrustSouth Manchester Hospitals TrustManchester Mental Health & Social Care TrustOther (specify)Not yet knownCo-Sponsorship Uni & CMMC TrustCo-Sponsorship Uni & Christie TrustCo-Sponsorship Uni & Mcr Mental Hth TrusCo-Sponsorship Uni & Salford Royal Hospitals TrustCo-Sponsorship Uni & South Manchester TrustThe University of Manchester
If ‘Other’ please specify:
Funder of Project
(if different to Sponsor): / Total Project Value (£s)
Name of Organisation receiving/ administering funds: / Is this a grant application?
Has a grant been awarded? / Yes No
Yes No
Intended Start Date:
(dd/mm/yy) / Intended End Date:
(dd/mm/yy)

2) Location

Sites (Facility and institution(s)) where the research will be conducted:
3) Ethics (For further information regarding NHS Research Ethics Committees, visit
Is a favourable ethics opinion required: / Yes No / Date Submitted (dd/mm/yy):
If a favourable ethics opinion has already been obtained, please give:
Committee Name: / Ref No:
LREC:
MREC:
University Ethics Committee: / Yes No
4) Type of research
Is the research a multi-centre project? / Yes No
If ‘Yes’ please specify name of Lead Organisation:
Name of Chief Investigator if different to Principal Investigator (given below)
5) Principal Investigator (PI)
Name: TitlePlease chooseDrProfessorMrMrsMsMiss / Forename(s): / Surname:
Tel: / Fax: / E-mail:
Job Title: / Employer Name:Please chooseChristie Hospital TrustCMMC TrustManchester Mental Health TrustSalford Royal Hospitals TrustSouth Manchester TrustThe University of ManchesterOther (please specify)
If Other (please specify): / Honorary Contract held?YesNo
If ‘Yes’ name issuing organisation:
NHS Trust Department: / University Division/ School Research Group:Please chooseMedicine - Cancer StudiesMedicine - Cardiovascular and Endocrine SciencesMedicine - Human DevelopmentMedicine - Medicine and Neuroscience - HopeMedicine - ISBEMedicine - Epidemiology and Health SciencesMedicine - Laboratory and Regenerative MedicineMedicine - Primary CareMedicine - PsychiatryMedicine - Medicine and SurgeryDentistryNursingPharmacyPsychological Sciences / Credit share of funding (%):
University staff only: % of effort to be spent on this project: %

6) Co-applicants (If you need to add any further applicants please provide details on separate sheet.)

Co-applicant 1
Name: TitlePlease chooseDrProfessorMrMrsMsMiss / Forename(s): / Surname:
Tel: / Fax: / E-mail:
Job Title: / Employer Name:Please chooseChristie Hospital TrustCMMC TrustManchester Mental Health TrustSalford Royal Hospitals TrustSouth Manchester TrustThe University of ManchesterOther (please specify)
If Other (please specify): / Honorary Contract held?YesNo
If ‘Yes’ name issuing organisation:
NHS Trust Department: / University Division/ School Research Group:Please chooseMedicine - Cancer StudiesMedicine - Cardiovascular and Endocrine SciencesMedicine - Human DevelopmentMedicine - Medicine and Neuroscience - HopeMedicine - ISBEMedicine - Epidemiology and Health SciencesMedicine - Laboratory and Regenerative MedicineMedicine - Primary CareMedicine - PsychiatryMedicine - Medicine and SurgeryDentistryNursingPharmacyPsychological Sciences / Credit share of funding (%):
University staff only: % of effort to be spent on this project: %
Co-applicant 2
Name: TitlePlease chooseDrProfessorMrMrsMsMiss / Forename(s): / Surname:
Tel: / Fax: / E-mail:
Job Title: / Employer Name:Please chooseChristie Hospital TrustCMMC TrustManchester Mental Health TrustSalford Royal Hospitals TrustSouth Manchester TrustThe University of ManchesterOther (please specify)
If Other (please specify): / Honorary Contract held?YesNo
If ‘Yes’ name issuing organisation:
NHS Trust Department: / University Division/ School Research Group:Please chooseMedicine - Cancer StudiesMedicine - Cardiovascular & Endocrine SciencesMedicine - Human DevelopmentMedicine - Medicine and Neuroscience - HopeMedicine - ISBEMedicine - Epidemiology and Health SciencesMedicine - Laboratory and Regenerative MedicineMedicine - Primary CareMedicine - PsychiatryMedicine - Medicine and SurgeryDentistryNursingPharmacyPsychological Sciences / Credit share of funding (%):
University staff only: % of effort to be spent on this project: %
Co-applicant 3
Name: TitlePlease chooseDrProfessorMrMrsMsMiss / Forename(s): / Surname:
Tel: / Fax: / E-mail:
Job Title: / Employer Name:Please chooseChristie Hospital TrustCMMC TrustManchester Mental Health TrustSalford Royal Hospitals TrustSouth Manchester TrustThe University of ManchesterOther (please specify)
If Other (please specify): / Honorary Contract held?YesNo
If ‘Yes’ name issuing organisation:
NHS Trust Department: / University Division/ School Research Group:Please chooseMedicine - Cancer StudiesMedicine - Cardiovascular and Endocrine SciencesMedicine - Human DevelopmentMedicine - Medicine and Neuroscience - HopeMedicine - ISBEMedicine - Epidemiology and Health SciencesMedicine - Laboratory and Regenerative MedicineMedicine - Primary CareMedicine - PsychiatryMedicine - Medicine and SurgeryDentistryNursing PharmacyPsychological Sciences / Credit share of funding (%):
University staff only: % of effort to be spent on this project: %
7) Declaration by Principal Investigator/ Researcher
The Principal Investigator and/ or researchers confirm this project complies, where appropriate, with the DH Research Governance Framework for Health and Social Care[2] and/ or all legal and statutory requirements (e.g. licences, authorisations and approvals) applying to the proposed work are observed and complied with. Please refer to Section 7 of the Guidelines.
Principal Investigator
Name: / Signature: / Date (dd/mm/yy):
8) Authorisation by University and/ or Trust (Official Use Only)
I/ we have reviewed the application, for which external funding is being sought or internal funding is available, and confirm that:
  1. The project is acceptable to and can be accommodated within the space available to this University Division or School/ Trust;
  2. If successful additional support from central funds, e.g. building alterations, running or maintenance costs or compensation for currency exchange fluctuation, or NHS Clinical service costs must have been agreed beforehand;
  3. Within the terms and conditions, the University will recover costs in line with the Faculty's pricing policy.

As Head of University Division/ School or Trust Authorised Signatory I accept that it is my responsibility to ensure that the University’s/ Trust’s Financial Regulations are adhered to in connection with any transactions charged to this project. I also accept that any deficits as a result of overspends against budget or ineligible expenditure which may arise will be recouped from other funds available to the University or Trust’s Clinical Department, or at School level as appropriate.
8a) University Authorisation:
Division/ School Leader/ Authorised Signatory for Principal Investigator: / Name:
Signature: / Date (dd/mm/yy):
Division/ School Leader/ Authorised Signatory for Co-applicant 1: / Name:
Signature: / Date (dd/mm/yy):
Division/ School Leader/ Authorised Signatory for Co-applicant 2: / Name:
Signature: / Date (dd/mm/yy):
Division/ School Leader/ Authorised Signatory for Co- applicant 3: / Name:
Signature: / Date (dd/mm/yy):
8b) NHS Trust(s) Authorisation:
When presenting your application for Trust approval please ensure that you provide a copy of the following (please tick):
  • Research funding application

  • Research protocol

  • Research ethics application

  • Favourable ethics opinion letter (if applicable)

  • Evidence of independent scientific or peer review
/ browse toPReviewNoW for assistance
Authorised Signatory for Trust:
Trust Name: / Name:
Signature: / Date (dd/mm/yy):
Authorised Signatory for Trust:
Trust Name: / Name:
Signature: / Date (dd/mm/yy):
9) Internal Review:
Has this proposal been subject to internal review by an authorised person within your School? Yes No
If ‘Yes’ please ask the relevant person to sign here:
Name: Signature
N.B. This application cannot be submitted unless it has been internally reviewed by your School.
10) Institutional Commitment:
Will this project require any Institutional commitment, either during the award period itself or following its completion? Yes No
If ‘Yes’ please ask the appropriate person within your School authorised to make this commitment to sign here:
Name: Signature

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Pan Manchester Research Notification Form (PMRNF)

CMMC Trust Authorisation Sheet

Title of Research Project:

Principal Investigator:

To be signed by the Clinical Director:

I am satisfied that this Directorate has the

  • necessary local research environment, i.e. facilities and resources, to host the research
  • that the researcher(s), specifically the local researchers, have the necessary expertise to conduct the research, and
  • that the research is appropriate to the local population

Signed:………………………………………………

Print Name:

Date:………………………………………………

To be signed by the Directorate Accountant:

I have checked the financial details of this proposed research project. I am satisfied that the research costs detailed are appropriate and that the costs have been properly identified in accordance with Trust and NHS guidelines. I am satisfied there will be no unmet costs to the Trust, and any service support costs and/or excess treatment costs have been agreed (HSG 97/32).

Signed:………………………………………………

Print Name:

Date:……………………………………………….

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[1] Please note that some R&D offices may require additional information before Trust approval can be given.

[2] DoH Research Governance Framework Version 2, 2005

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