Application summary Application title How long would you like your funding to last? (months) When would you like your funding to start? Are you applying through an organisation? Has this organisation applied for Wellcome funding before? Has this organisation received Wellcome funding? Name of administering organisation Address where the grant will be held Department/Division Organisation Street City/Town Postcode/Zipcode Country Lead applicant Lead applicant details Full Name Department Division Organisation Page 1 of 6
Address Line 1 City/Town Postcode Country Telephone No. Email Address Have you applied for Wellcome funding before? Have you received Wellcome funding? Team members Are there any additional people working with you on this activity? Please provide details of key team members Name Organisation Email address Role in the work Proposal Tell us about your idea in detail We strongly recommend breaking your answer down into four parts: 1. What do you want to do and how are you going to do it? 2. Who will this work be relevant to and why? This could include intended participants, community groups, audiences, or professional groups. If you have specific demographics in mind, include those too. 3. What activity or knowledge is this work building on and why is now the right time to do it? Refer to previous relevant work that you or others have done and other events that have inspired your idea. 4. What changes are you hoping to see as a result of this work? These could be immediately measurable or contribute to a longer term change. (850 words max.) Give us a summary of your idea Page 2 of 6
This should summarise your proposal and highlight the most important points from the previous question. (200 words max.) Currency requested Please select the currency in which you wish to apply. Is the selected currency your local currency? What is your local currency? Please state clearly the reasons for requesting costs in the selected currency (100 words max.) Costs What do you expect to be the total cost of the work you are doing? Please divide the total between the categories below. We understand that things change, so these can be estimates. This should include all associated spending, not just Wellcome funding. You don't need to include inkind support. Salaries Fees Materials and consumables Equipment Production costs, press & marketing Travel and subsistence Evaluation and dissemination Capital costs Page 3 of 6
Miscellaneous costs Contingency Total cost () What is the total amount you are requesting from Wellcome? Please round the figure up to the nearest 1,000. Wellcome funding can't be used to cover retrospective costs. Miscellaneous other Total Do you hope to receive any other income? This might include charitable grants, commissions or fees for work Please provide details of other income Income source Amount Confirmed or expected Date confirmed or expected Administrative details Overall category Please select an overall category for your proposal Arts Entertainment media Museums & heritage Leisure, sport & tourism Page 4 of 6
Education & learning Community, charity & public sector If you have selected 'Other' as a sub-category, please specify Activity locations Is your activity taking place in the UK and/or Republic of Ireland? Please select region(s) Is your activity taking place in a low- or middle-income country? Please select region(s) and country(s) Public engagement area of science Please select up to three categories that are relevant to your application Please specify Supporting material Would you like to include any supporting material? We will shortlist proposals based on your answers above, so make sure you ve already included all the important information. If you feel there s important supporting information that helps to illustrate your proposal you can upload it here, but we can t guarantee to look at it. To submit supporting information, please provide a single page pdf document containing web links that point to the location of your support material. You should make sure that we can access any confidential materials that are not publicly available. Support material could include: draft scripts or treatments links to still or moving images e.g. YouTube or Flicker reviews or reports of previous activity Page 5 of 6
working diagrams or plans to illustrate your work As a rough guide we would expect supporting information to be drawn from existing material, not things created specifically for this application. Please note we cannot accept support material in hard copy format. Page 6 of 6