TRADIM Research Grants

Trauma and disaster management (Tradim)

research grants

2017 Application Form

1. Small Grants
2. Project Grant

CLOSING DATE: 5:00 pm Monday 8 August 2016

Small Grants ($20,000) provide seed funding for research studies that have the potential to build capacity. Applicants should demonstrate the potential for the research to improve health outcomes through evidence based practice. Two grants will be available.

The Project Grant ($50,000) provides stand-alone support for a defined project that demonstrates potential for the research outcomes to be translated into improved health outcomes through evidence based practice, and/or result in future national or international grants. One grant will be available.

Application Instructions

Refer to the Trauma and Disaster Management (TRADIM) Research Grant Funding Guidelines for funding commencing in 2017 document when preparing your application.

The application MUST be prepared using the supplied application form. Complete all sections as incomplete applications may not be considered.

Press <Tab> to move between fields.

The applicant is required to sign the application on behalf of the research team.

Submission

Applications must be submitted electronically to :

1. A signed copy of the application to be submitted as a PDF,

The application must also be submitted in Word format (signatures not required).

Files must not exceed 2 MB in size and should be named using the following naming convention:

Applicant Surname_2017 TRADIM Funding type*

E.g., Smith_2017 TRADIM Small

*Funding types – Small, Project

Applications must be received by the Centres for Health Research

no later than 5:00 pm Monday 8 August 2016

Late or incomplete applications will not be accepted

Enquiries

Enquiries regarding the TRADIM Research Grant Scheme should be directed to:

PAH Research Grants Administration Officer

Email:

Trauma and Disaster Management Research Grant Scheme Page ii

TRADIM Research grants

2017 Application form

Research Grant Application Type

Small Grant
Project Grant

Project Title

(Maximum 200 characters including spaces)

Investigative team

The Applicant must be the Principal Investigator (PI). Up to 4 Co-Investigators (CIs) and 2 Associate Investigators (AIs) may be included.

Title / Name / Health Profession / Organisation
PI / Click to chooseProfA/ProfDrMrMrsMs / First name Surname / Click to chooseMedicalAllied HealthNursingResearch OnlyOther / Click to chooseMSHRDHNCCTRC
CI1 / Click to chooseProfA/ProfDrMrMrsMs / First name Surname / Click to chooseMedicalAllied HealthNursingResearch OnlyOther / Click to chooseMSHRDHNCCTRCOther
CI2 / Click to chooseProfA/ProfDrMrMrsMs / First name Surname / Click to chooseMedicalAllied HealthNursingResearch OnlyOther / Click to chooseMSHRDHNCCTRCOther
CI3 / Click to chooseProfA/ProfDrMrMrsMs / First name Surname / Click to chooseMedicalAllied HealthNursingResearch OnlyOther / Click to chooseMSHRDHNCCTRCOther
CI4 / Click to chooseProfA/ProfDrMrMrsMs / First name Surname / Click to chooseMedicalAllied HealthNursingResearch OnlyOther / Click to chooseMSHRDHNCCTRCOther
AI1 / Click to chooseProfA/ProfDrMrMrsMs / First name Surname / Click to chooseMedicalAllied HealthNursingResearch OnlyOther / Click to chooseMSHRDHNCCTRCOther
AI2 / Click to chooseProfA/ProfDrMrMrsMs / First name Surname / Click to chooseMedicalAllied HealthNursingResearch OnlyOther / Click to chooseMSHRDHNCCTRCOther
Office Use Only / Application number:
TRADIM / 2 / 0 / 1 / 7

Trauma and Disaster Management Research Grant Scheme Applicant:

Eligibility Checklist

To be eligible for a 2017 TRADIM Small or Project Research Grant, the Applicant must be able to answer:
· YES to questions 1-5
· NO to question 6 / YES / NO
1 / Are you a member of staff of Metro South Health, Royal Darwin Hospital or the NCCTRC?
2 / Will you be employed in the above appointment at least 0.5 FTE for the duration of the grant?
3 / Will the majority (more than 50%) of the research take place:
1. Within a Metro South Health Site?
2. At the Royal Darwin Hospital?
3. In a NCCTRC-approved partnership service facility or organisation within Queensland or the Northern Territory?
If iii, provide details of the NCCTRC-approved partner service facility or organisation in the space provided below.
4 / Is at least one member of the investigative team a medical doctor, nurse or allied health professional?
5 / Does the investigative team contain a member of staff from Metro South Health Service OR the Royal Darwin Hospital or NCCTRC?
6 / Is the proposed research activity currently funded through an award type currently listed on the Australian Competitive Grants Register or international equivalent?

Details of NCCTRC-approved partner service facility/organisation

If you answered YES to Question 3iii above, provide details of the NCCTRC-approved partnership service facility or organisation including location, who approved the service facility/organisation and when it was approved (maximum 300 characters including spaces).

Eligibility Certification

I, [First Name, Surname], certify that I meet the relevant eligibility criteria for the TRADIM Research Grant Scheme.

TRADIM Research Grant Application Page 14

Trauma and Disaster Management Research Grant Scheme Applicant:

Signature of Applicant: Date:

TRADIM Research Grant Application Page 14

Trauma and Disaster Management Research Grant Scheme Applicant:

If you have questions concerning your eligibility for the TRADIM Research Grant Scheme, contact

PAH Research Grants Administration Officer

Email:

TRADIM Research Grant Application Page 14

Trauma and Disaster Management Research Grant Scheme Applicant:

1. Principal Investigator (applicant)

1.1. PI Contact Details

PI name / Click to chooseProfA/ProfDrMrMrsMs First Name Surname
Position
Organisational Department / Department name
Phone numbers / Primary: / Secondary:
Email address
Postal Address / Address line 1
Address line 2
Address line 3
Suburb and Postcode

1.2. PI Academic Qualifications

Qualification / Awarding Institution / Date /
DD/MM/YEAR
DD/MM/YEAR
DD/MM/YEAR
DD/MM/YEAR

1.3. Participation

Summarise your participation in the broad research plan proposed in this application (maximum 300 characters including spaces)

1.4. PI Research Time

Expected 2016 time allocation to: / This study (hr/wk): / Other studies (hr/wk):
Do you expect to have an extended period of absence during 2016? / Yes No
If Yes, provide expected dates / DD/MM/YEAR - DD/MM/YEAR
Reason
(300 characters including spaces)

1.5. PI Publications

List publications produced in the last 5 years with List ALL authors provided

· Indicate publications relevant to this application with an asterisk (*)

· Press <Enter> after each publication to maintain the numbering system

1.6. PI Grants

Provide details of research funding received in the last 5 years and indicate whether the funding relates to the proposed research of this application

If there is insufficient space in the below table just include the most relevant grants to this application.

Funding body and type / Start date
End date / Amount / Relevant to this application? /
[DD/MM/YYYY]
[DD/MM/YYYY] / $ / Yes
No
[DD/MM/YYYY]
[DD/MM/YYYY] / $ / Yes
No
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No
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No
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No
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No
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No
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No
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No
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No
[DD/MM/YYYY]
[DD/MM/YYYY] / $ / Yes
No

TRADIM Research Grant Application Page 14

Trauma and Disaster Management Research Grant Scheme Applicant:

2. Co-Investigator 1

2.1. CI1 Contact Details

CI1 Name / Click to chooseProfA/ProfDrMrMrsMs First Name Surname
Position
Organisation and Department / Organisation and Department name
Phone number
Email address

2.2. CI1 Academic Qualifications

Qualification / Institution / Date /
DD/MM/YEAR
DD/MM/YEAR
DD/MM/YEAR
DD/MM/YEAR

2.3. CI1 Participation

Summarise the role of CI1 in the broad research plan proposed in this application (maximum 300 characters including spaces)

2.4. CI1 Research Time

Expected 2016 time allocation to: / This study (hr/wk): / Other studies (hr/wk):
Does CI1 expect to have an extended period of absence during 2016? / Yes No
If Yes, provide expected dates / DD/MM/YEAR - DD/MM/YEAR
Reason
(300 characters including spaces)

2.5. CI1 Publications

List CI1 publications produced in the last 5 years with List ALL authors provided

· Indicate publications relevant to this application with an asterisk (*)

· Press <Enter> after each publication to maintain the numbering system

2.6. CI1 Grants

Provide details of research funding received by CI1 in the last 5 years and indicate whether the funding relates to the proposed research of this application

If there is insufficient space in the below table just include the most relevant grants to this application.

Funding body and type / Start date
End date / Funding Amount / Relevant to this application? /
[DD/MM/YYYY]
[DD/MM/YYYY] / $ / Yes
No
[DD/MM/YYYY]
[DD/MM/YYYY] / $ / Yes
No
[DD/MM/YYYY]
[DD/MM/YYYY] / $ / Yes
No
[DD/MM/YYYY]
[DD/MM/YYYY] / $ / Yes
No
[DD/MM/YYYY]
[DD/MM/YYYY] / $ / Yes
No
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No
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No
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No
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No
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[DD/MM/YYYY] / $ / Yes
No
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[DD/MM/YYYY] / $ / Yes
No
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No
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No
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No
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No
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No
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[DD/MM/YYYY] / $ / Yes
No
[DD/MM/YYYY]
[DD/MM/YYYY] / $ / Yes
No

TRADIM Research Grant Application Page 14

Trauma and Disaster Management Research Grant Scheme Applicant:

3. Co-Investigator 2

3.1. ci2 Contact Details

CI2 Name / Click to chooseProfA/ProfDrMrMrsMs First Name Surname
Position
Organisation and Department / Organisation and Department name
Phone number
Email address

3.2. CI2 Academic Qualifications

Qualification / Institution / Date /
DD/MM/YEAR
DD/MM/YEAR
DD/MM/YEAR
DD/MM/YEAR

3.3. CI2 Participation

Summarise the role of CI2 in the broad research plan proposed in this application (maximum 300 characters including spaces)

3.4. CI2 Research Time

Expected 2016 time allocation to: / This study (hr/wk): / Other studies (hr/wk):
Does CI2 expect to have an extended period of absence during 2016? / Yes No
If Yes, provide expected dates / DD/MM/YEAR - DD/MM/YEAR
Reason
(300 characters including spaces)

3.5. CI2 Publications

List CI2 publications produced in the last 5 years with List ALL authors provided

· Indicate publications relevant to this application with an asterisk (*)

· Press <Enter> after each publication to maintain the numbering system

3.6. ci2 Grants

Provide details of research funding received by CI2 in the last 5 years and indicate whether the funding relates to the proposed research of this application

If there is insufficient space in the below table just include the most relevant grants to this application.

TRADIM Research Grant Application Page 14

Trauma and Disaster Management Research Grant Scheme Applicant:

4. Co-Investigator 3

4.1. cI3 Contact Details

CI3 Name / Click to chooseProfA/ProfDrMrMrsMs First Name Surname
Position
Organisation and Department / Organisation and Department name
Phone number
Email address

4.2. CI3 Academic Qualifications

Qualification / Institution / Date /
DD/MM/YEAR
DD/MM/YEAR
DD/MM/YEAR
DD/MM/YEAR

4.3. CI3 Participation

Summarise the role of CI3 in the broad research plan proposed in this application (maximum 300 characters including spaces)

4.4. CI3 Research Time

Expected 2016 time allocation to: / This study (hr/wk): / Other studies (hr/wk):
Does CI3 expect to have an extended period of absence during 2016? / Yes No
If Yes, provide expected dates / DD/MM/YEAR - DD/MM/YEAR
Reason
(300 characters including spaces)

4.5. CI3 Publications

List CI3 publications produced in the last 5 years with List ALL authors provided

· Indicate publications relevant to this application with an asterisk (*)

· Press <Enter> after each publication to maintain the numbering system

4.6. CI3 Grants

Provide details of research funding received by CI3 in the last 5 years and indicate whether the funding relates to the proposed research of this application

If there is insufficient space in the below table just include the most relevant grants to this application.

TRADIM Research Grant Application Page 14

Trauma and Disaster Management Research Grant Scheme Applicant:

5. Co-Investigator 4

5.1. CI4 Contact Details

CI4 Name / Click to chooseProfA/ProfDrMrMrsMs First Name Surname
Position
Organisation and Department / Organisation and Department name
Phone number
Email address

5.2. CI4 Academic Qualifications