New Ideas Awards 2016 application form Research Awareness Support (Note: update 03.06.2016 the link to the Research involvement Network has been updated) Please read this form along with the guidance notes and The Brain Tumour Charity s Terms and Conditions before completing this application. Once completed, please email this form as an attachment to research@thebraintumourcharity.org by the closing date of: 17.00 (London time zone), 16 August 2016. A signed hard copy of the application form should be sent within seven working days of this deadline to: Research Department, The Brain Tumour Charity, Hartshead House, 61-65 Victoria Road, Farnborough, GU14 7PA. Section 1: Application information Title of project: Amount requested: Expected start date: Duration of project: Section 2: Applicant details Principal investigator contact details Name (including title): Address: Postcode: Phone: Email: Co-applicant names and institutions Co-applicant (1): Co-applicant (2): Co-applicant (3): Name (including title) Institution (including any affiliated institutions) Email Time spent by applicants on research
Name Principal investigator: Co-applicant (1): Co-applicant (2): Co-applicant (3)*: Time on research (hours/week) Time spent on this research programme (hours/week) Section 3: Research Summary Lay Summary (Up to 300 words) Please provide a summary of the research proposed in plain English. This summary should address the following questions: The aims of the research project Why this research is needed Relevance of research to people with a brain tumour How the research proposed is novel and ground-breaking Do not include any confidential or sensitive information in this section. Please see the guidance notes for further information. Summary of research in one sentence (Up to 40 words) Please describe your project using lay terms, in one sentence, to be used by The Charity Keywords Which keywords best describe your research, including which tumour type(s) will it focus on? These will be used in the first instance to find peer reviewers for your application. Multi pick list (from Mariana) with option for multiple others Please tick all categories which are relevant to your research: High grade tumour(s) Low grade tumour(s) Paediatric tumour(s) Adult tumour(s) Section 4: Project details Scientific Summary (Up to 200 words) Please provide a summary of the research proposed for a scientifically qualified assessor. Detailed research proposal (up to 4 pages, minimum size 10 font with single spacing) Please provide full details of your proposal. These should include: Aims Rationale for pursuing this question How the research proposed is novel Strategic importance of this research into brain tumours
Objectives and key deliverables. You may include figures within this proposal however they will count towards the page limit. References Please provide citations for the research proposal in full, including title of paper and all authors. Timelines and milestones Please provide details of key milestones for the grant, along with a Gantt chart for the proposed research. If your application is successful, this will be used to monitor the progress of the project. Timeline (in months) Milestones description Relevance to research priorities (up to 400 words) Please outline how the proposed research addresses the research priorities outlined in our research strategy: A Cure Can t Wait. Specifically, please outline how your research fits with our Accelerate, Diagnose, Understand, Catalyse and/or Enhance priorities. Facilities and resources available to the team (up to 300 words) Outline the facilities and resources available Future work (up to 400 words) Please provide details of where you anticipate the study to lead and how this work will be taken forward? Public Patient/Community Involvement (PPI) (up to 400 words) In preparation for your submission, we would encourage you discuss your application with patients or carers. Please outline how this stakeholder group has been involved in the development of this research project. You may choose to access our Research Involvement Network (RIN) which can provide you with this. www.thebraintumourcharity.org/ppi Section 5: Project impact Potential for patient benefit (up to 300 words)
Please outline what the expected and/or potential benefits arising from this research for people living with a brain tumour could be. Indicate the likely timescale for these outcomes and explain the reasons for the suggested timescale. (Timescales: 1-2 years, 3-5 years, 5-10 years, more than 10 years) drop down Dissemination plans (up to 200 words) Please describe how you will disseminate this grant s results during and after the conclusion of the project. Working with The Brain Tumour Charity during the grant period (up to 300 words) How will you work with The Charity and its supporters to promote our work and the impact of your research over the course of the grant and subsequently? In addition, as per our Terms and Conditions, how will you ensure patients and carers have access and/or are made aware of our materials and services? Section 6: Current funding Current funding (up to 500 words) For the Principal Investigator and all co-applicants: Please list current research funding and funding obtained in the last 5 years. Please state the name of the funding body, title of project, amounts awarded and start and end dates of support. Related applications Please outline related applications currently under consideration and describe how they relate to this project Section 7: Costing and justification Summary of Requested Costs Directly incurred costs only Amount requested Please provide a brief justification of the funds requested for this project. Please also outline how any matched funding will be used. Salaries Materials and consumables Animals Equipment Travel
Miscellaneous Salaries Staff name (if known, if not please write to be appointed ) Staff category (e.g. PDRA, technician) Period on grant (months) % of full time Total cost on grant TOTAL Materials and consumables Total Animals (detail species and number of animals to be used) *** Species Number Total Total purchase cost Total maintenance cost Total purchase cost Total maintenance cost Equipment Travel Miscellaneous
Section 8: Commercial Exploitation and Competing Interests Do any of the applicants have consultancies, or any equity holdings in, or directorships of, companies or other organisations that might have an interest in the results of the proposed research? (up to 200 words) If yes, please give brief details. Will the proposed research use technology, materials or other invention that, as far as you are aware, are subject to any patents or other form of intellectual property protection? (up to 200 words) If yes, please give brief details. Is the proposed research, in whole or in part, subject to any agreements with commercial, academic or other organisations? (up to 200 words) If yes, please give brief details. Is the proposed research likely to lead to any patentable or commercially exploitable results? (up to 200 words) If yes, please give brief details. Section 9: Ethical and Legal requirements Does the research project require the approval of an ethics committee, certification of the institute at which the research will be conducted, personal licences for individual researchers, a project licence, or any other permissions or legal documentation? Please provide details and supporting documentation, including whether these have been obtained, or if not yet obtained, when this is expected to happen. Please append ethical approvals and licences to the end of the application. *** Please give details of the species being used and whether they have been genetically modified. *** Why is the use of animals necessary; are there any other possible approaches? (250 words max)
*** Why is this species/model the most appropriate? (250 words max) *** Please justify the number of animals to be used per experiment, including details of any sample size calculations and/or statistical advice sought. (500 words max) *** Please select the severity of the procedures being used and describe how they have been optimised to reduce discomfort of the animals being used. (250 words max) Mild / Moderate / Severe Section 10: Collaboration Collaborators for this project Please provide the collaborator s name and nature of the collaboration below. In addition, please attach letters of collaboration from all those listed. Nature and extent of Name of Collaborator Institution collaboration Section 11: Other information Please tell us where you heard about this call (drop down) The Brain Tumour Charity e-newsletter The Brain Tumour Charity website Research Professional database (from Research Research Ltd) University newsletter Colleague Other (please give details) Peer reviewing Please suggest referees Reviewers we may contact Reviewers you don t want us to contact (where there is a direct conflict of interest)
Section 12 Data protection The Brain Tumour Charity Data Protection Statement Information that you supply to The Brain Tumour Charity in connection with this application (which includes all information sent to The Charity that relates to your grant application) is held on secure databases in the USA and the UK and will be used to process your application and for the purpose of audit and/or evaluation. It will be disclosed to external peer reviewers some of whom may be based outside the European Economic Area (EEA) and may also be passed to other potential funders. All parties with whom this information is shared will be required to keep it securely and in confidence. The Brain Tumour Charity may publish details of successful grant applications into the public domain. The Brain Tumour Charity may contact you about its work and other award schemes/initiatives that may be of interest to you, or for your views on its funding schemes and application processes. If you would prefer not to receive further communications please let us know. The information you provide will be held securely in accordance with The Brain Tumour Charity s internal policy and the Data Protection Act 1998. If The Brain Tumour Charity shares the information you provide with co-funders it requires the details to be held under similar terms. For more details please contact us. Section 13 Undertakings I the undersigned confirm that I (and all those providing personal information in the application) have read and understood The Brain Tumour Charity s Data Protection Statement above. I have not changed, added to, or deleted from the text in any of the instruction or question boxes in this Application Form. I confirm that I have read, understood and accept the The Brain Tumour Charity s Terms and Conditions. I have read and approve this completed application form. If granted, the work will be accommodated and administered in the department/institution in accordance with the grant conditions. I also confirm that there are no existing matters which would be a breach of any conditions which have not been brought to your attention in writing. I understand that if the provision of any false or inaccurate information in this application would be considered very seriously and may result in disqualification of the application. To the best of my knowledge, the information provided in this application is accurate and complete. Print name: Signature: Date: Principal Investigator Co-applicant 1 Co-applicant 2 Co-applicant 3* Senior administrative authority on behalf of the Lead Institution