2018 Health Professional Scholarship

Transcription

1 2018 Health Professional Scholarship Page 1 of 22 Instructions to Applicants Welcome to the Heart Foundation's online application form. We would appreciate any feedback regarding our new online application process. Please send your feedback by to: research@heartfoundation.org.au Award Details Instructions for completing this application, along with Eligibility and Award Stipulations can be found on our website: Please read these instructions carefully before submitting. All initial questions should be directed to the research office of your institution. The closing date for application is: Friday 22nd June 2018 at 5pm AEST. Late or incomplete applications will not be accepted. It is recommended that you submit this application to your Research Office by Friday 15th June Important Information Before submission, you will have an opportunity to review and print the application. Once you submit you will not be able to access or make changes to your application while it is under review by your Research Office. The Research Administration Officer at your Administering Institution will review your application and either endorse it or request changes to the application. If the application is endorsed, it will be submitted to the Heart Foundation - no further action will be required by the applicant. If the Research Administration Officer requires changes to the application, you will be notified via . The Heart Foundation will reinstate your access to your application to enable you to make changes (allow up to one business day). Once you have made your changes you must resubmit your application to the Administering Institution for final endorsement. The Heart Foundation will not make requests for missing documentation or provide opportunities to amend incorrectly completed applications. Incomplete or incorrect applications will not be forwarded for peer review. Privacy Statement Your Personal Information is being collected by the Heart Foundation in order to assess your application for this award. If you are not successful in your application we will retain your application on file indefinitely. If you are successful in your application, then we will use your Personal Information to manage your award. We respect your privacy and embrace the principles contained in the Privacy Act. The Heart Foundation (we, us, our) is the National Heart Foundation of Australia and all associated Australian State and Territory Heart Foundation Divisions, full details of which can be found in our Privacy Notice. If you do not want to receive further communication from us (other than information that relates to this application and successful award) or if you have any questions about privacy please contact the Research Program at research@heartfoundation.org.au or call (03) Our APP privacy policy is set out in our Privacy Notice and details how you may complain about privacy issues and how we would deal with that complaint. It also explains how you can access, correct or update information we hold about you. A copy of our Privacy Notice is available at or on request. [HFPS F] Acceptance of Use By continuing with this application you accept the Heart Foundation Online Grants Management System Terms and Conditions of Use.

2 Page 2 of 22 - Project Overview Simplined Project Title Insert lay title character maximum Scientinc Project Title Insert scientific title character maximum Project Start Date Insert start date: - Q1 Jan 2019 or Q2 1 April 2019 or Q3 1 July 2019 Research Category Insert category the research applies to Nominated FTE Rating The FTE you will spend on your Health Professional Scholarship. Please note, stipend will be based on this FTE Project Synopsis/Outcomes: Using lay terms, describe the overall aims of the research and expected cardiovascular health outcomes. Avoid technical terms. Your answer should be suitable for release to media and general publications. Insert project brief which will be assessed and added to the Heart Foundation website (if the project is successful) character maximum

3 Page 3 of 22 - Research Categories - Examples Biology Hormones Condition Hypertrophy Demographics Ageing Diagnosis & Assessment Blood Tests Risk Factors Energy Drinks Treatment Transplant Prevention Omega-3 Fatty Acids & Fish Oils Information Technology Social Media Categories Selected 8

4 Page 4 of 22 - Applicant Information Applicant Title Insert your title First Name Insert your first name Last Name Insert your surname Insert your address Landline (include Area Code) Insert your work phone number Mobile Insert your mobile number Resident Status Select appropriate response Gender Select appropriate response Are you of Aboriginal or Torres Strait Islander descent? Select appropriate response Attach PDF of Resident Status evidence (Passport etc) - PDF files only (Max 20MB) - And evidence of name change if applicable. Please name your file using the following convention: Last Name_2018_HPS_Citizenship or Residence Evidence (e.g. Smith_2018_HPS_Citizenship or Residence Evidence)

5 Page 5 of 22 - Applicant Current Work Information Position Insert your current employment position title Employer Insert your current employer Position Start Date Insert the start date of this position FTE Insert FTE you are currently working at this organisation

6 Page 6 of 22 - Administering Institution Institution Name select the Institution who will administer this award Administering Institution Contact Person Details Title select the research administering officer's title First Name insert the research administering officer's first name Last Name insert the research administering officer's surname Landline (include Area Code) insert the research administering officer's phone number Institution Address select the research administering officer's address This contact person will undertake a final review of your application prior to submission to the Heart Foundation. Please ensure the privacy statement on the Heart Foundation website is acknowledged by the contact person.

7 Page 7 of 22 - Current Supervisor Details Supervisor Title Insert your current supervisor's title Supervisor First Name Insert your current supervisor's nrst name Supervisor Last Name Insert your current supervisor's surname Supervisor Institution Insert your current supervisor's current employer Supervisor Position Insert your current supervisor's title at the Institution

8 Page 8 of 22 - PhD Status Have you commenced your degree? Select 'Yes' or 'No' Course Start Date insert the PhD start date Full Time Equivalent (in Months) Select appropriate response Course Enrolment Please upload evidence of PhD Enrolment. PDF files only (Max 20MB). Please name your file using the following conventions: Last Name_2018_HPS_PhD Course Enrolment or PhD Intending to enrol (e.g. Smith_2018_HPS_PhD Course Enrolment or PhD Intending to enrol) If you have yet to enrol in a PhD, a signed letter from your administering institution indicating that you are in the process of enrolling for a PhD should be inserted Continued Cardiovascular Health: How do you intend to continue your cardiovascular health practice during your PhD? Please discuss Motivation: Why do you wish to undertake a PhD at this time in your career? What are your overall career aspirations? Please discuss

9 Page 9 of 22 - Other Funding Scholarship Scholarship Name enter name of your awarded scholarship Scholarship Start Date enter scholarship start date Scholarship End Date enter scholarship end date Scholarship Provider enter the name of the scholarship provider Other Funding Funding Body please insert the name of the funding body you have applied to or intend to to for other funding e.g NHMRC. Funding details. Include: - Award type, - Name, - Category and reference/ application number if known) enter the details of the funding you have applied for character maximum

10 Page 10 of 22 - Project Outcomes Project Aims and Hypothesis - Provide a summary of the aims and hypothesis of your project. Insert Information character maximum Relevance to Cardiovascular Health - Indicate the relevance and impact of your project to cardiovascular health. Insert Information characters maximum

11 Page 11 of 22 - Ethics Approvals Is ethics required? select 'Yes' or 'No' Please select the ethic requirements associated with your research: Yes - select ethics approvals applicable to award Please attach information supporting ethics approval or clearance (if available). Please attach information supporting ethics approval or clearance (if available) - Only PDF documents are acceptable. The PDF files must not exceed 20MB. If any of the ethics clearances listed above are not required in order to commence the proposed work, please detail the reasons why and indicate the date when the ethics clearances will be required. Insert information as required characters maximum All ethics approvals and clearances necessary to complete the project outlined in this application must be forwarded to the Heart Foundation within 30 days of receipt of approval.

12 Page 12 of 22 - Quali cations Qualification Type Your three most recent qualification details select qualification Qualification Year select year qualification has been completed Qualification Name insert name of qualification character maximum Educational Institution insert the institution character maximum Qualification Type select second qualification Qualification Year select year qualification has been completed Qualification Name insert name of qualincation character maximum Educational Institution insert the institution character maximum Qualification Type Example - Masters Degree Qualification Year 2012 Qualification Name Masters of Public Health Educational Institution The University of Sydney

13 Page 13 of 22 - Awards Award Detail Your top five awards and acheivements Description of Award/Achievement insert name of award/achievement awarded character maximum Provider of Award/Achievement name of the provider of the award/achievement character maximum Award / Achievement Year select year award/achievement was received Award Detail Description of Award/Achievement Example: Heart Foundation Research Medal for Lifetime Contribution to Cardiovascular Research Provider of Award/Achievement The Heart Foundation Award / Achievement Year 2017

14 Page 14 of 22 - Track Record Research Involvement: insert information character maximum Have you had any previous involvement in research? If so please briefly describe this involvement. Cardiovascular Health Practice: insert information character maximum Supply details of your track record in cardiovascular health practice. Please ensure that the relevance of your work to cardiovascular health is clear.

15 Page 15 of 22 - Applicant Work History Previous Appointments (In order of most recent) Position insert your most recent position title Employer insert your most recent previous employer Position Start Date 01/01/2017 Position End Date 01/02/2017 Previous Appointments (In order of most recent) Position Example - Clinician Employer Royal Adelaide Hospital Position Start Date 01/01/2017 Position End Date 03/04/2018

16 Page 16 of 22 - Publications Publication Detail Please attach list detailing any publications that have been published, or accepted for publication, in refereed journals in the past five years (maximum 50). Do not include conference abstracts or submitted publications that have yet to be accepted. Each reference should include: - Applicant Author Status (e.g. First Author, Middle Author, Last Author), - Publication Title, Authors, - Journal Title, - Publication Year, - Volume, - Page Number. Please add impact factors and citations for each publication as well as the relative ranking or importance of each journal within its field (if available). Upload publications must be numbered with a maximum of 50. Publications list must be uploaded as a PDF (20MB max). Any publications additional to the initial 50 will not be considered. Please name your file using the following convention: Last Name_HPS_Publications (e.g. Smith_2018_HPS_Publications) From the above attached list, please list your top five publications (including fields note above) and discuss in detail its impact on cardiovascular research character maximum.

17 Page 17 of 22 - Presentations Please attach list detailing any presentations at national and international conferences that you have given in the past 5 years (maximum 50). Ensure you provide the following information for each presentation: - Presentation type (e.g. Oral Presentation, Poster Presentation, or Other Presentation), - Invited: (Yes/No), - Title, - Conference Name, - Location (International/National/State/Local) and - Date. Presentations list must be uploaded as a PDF (20MB Max). Any presentations additional to the initial 50 will not be considered. Please name your file using the following convention: Last Name_2018_HPS_Presentations (e.g. Smith_2018_HPS_Publications)

18 Page 18 of 22 - Project Plans Summary of Project Plan: Please provide a brief summary of your project plan. Discuss the project plan character maximum Research Environment: Briefly summarise the research environment including: Discuss the research environment character maximum - quality/experience of supervision, - international standing of lab, - facilities, - infrastructure and funding that is available to support your proposed research.

19 Page 19 of 22 - Research Plan and Figures Please provide a detailed Research Plan. The Research Plan is limited to two pages, including a maximum of 15 references, and must be completed using Arial 12 point font. Please name your file using the following convention: Last Name_2018_HPS_Research Plan and Figures (e.g. Smith_2018_HPS_Research Plan and Figures)

20 Page 20 of 22 - Health Equity The Heart Foundation is committed to addressing health inequity and to focusing on people who are disproportionately affected by heart disease: people who are socioeconomically disadvantaged, residents of regional, rural and remote areas, Australians from culturally and linguistically diverse backgrounds, and Aboriginal and Torres Strait Islander peoples. This question will not form part of the assessment of your application. Please describe how your research will be considered (or has considered) these populations? Select appropriate response Please provide details: insert information character maximum

21 Page 21 of 22 - Referees Referee Details- Please supply two Referee Title select your referee's title First Name insert your referee's first name Last Name insert your referee's surname insert your referee's address Landline (include Area Code) insert your referee's phone number Mobile insert your referee's mobile phone number Position insert your referee's position at their institution Institution insert the organisation your referee is employed at Please describe your relationship with this referee insert information on your collaborations/employment history etc relevant to the award- 200 character maximum Referee Details - Example Referee Title Professor First Name Jane Last Name Doe example@example.com Landline (include Area Code) Mobile Position Research Fellow Institution University of Melbourne Please describe your relationship with this referee Professor Doe has collaborated on B projects in year C Professor Doe has D experience and E publications In completing the referee s details, I verify that I have the endorsement of the referees and permission to provide their details. The referees and myself have acknowledged the privacy statement.

22 Page 22 of 22 - Submit For Endorsement Submit For Endorsement Following this certification page, you will have the opportunity to review your full application prior to sending to your Research Office. You will be able to go back and make changes if necessary. Once the application is submitted you will not be able to make changes. By submitting this form, an notification will be sent to both the Heart Foundation and the Research Office at your Administering Institution. Your Research Office will review the application and either endorse it or return it for amendments. You will receive an notification advising of the status of this application only when your Research Office has endorsed or returned your application. If you or the Administering Institution do not receive notifications, please check your spam folders and settings. Certification I certify that all details provided in this application are correct and that I have read, understood, and have abided by the instructions associated with this application. I confirm that all applicable parties (including Head of Department, Supervisors, Referees and Other Investigators) have reviewed and approved my application, and I have provided evidence of these approvals and agreements to my Administering Institution's Research Office. I also confirm that all applicable parties have read and understood the privacy statement. I agree to carry out the project in accordance with the principles of the Australian Code for the Responsible Conduct of Research (2007). I acknowledge that all ethics approvals and clearances necessary to complete my project as outlined in this application will be in place before commencement of the work. I also acknowledge that all supporting documentation has been provided with this application. I understand that my application will not be eligible for consideration by the Heart Foundation if this application is incomplete or lacking the required documents. I confirm that I have complied with all instructions and understand that failure to do so may result in the withdrawal of the application from the review process. By submitting this form, I understand my application will be reviewed by the Research Administration Officer at my Administering Institution for endorsement and final submission to the Heart Foundation.