Application summary Type of award Please select the type of award you are applying for Application title Proposed duration of funding (months) Proposed start date Name of administering organisation Lead applicant's address at administering organisation Department/Division Organisation Street City/Town Postcode/Zipcode Country Research funding area Please select from the drop-down list the funding area that you consider your research falls under Lead applicant Lead applicant details Full Name Department Division Page 1 of 7
Organisation Address Line 1 City/Town Postcode Country Telephone No. Email Address Career history (current/most recent first) From To Position Organisation Education/training From To Qualification Subject Organisation Source(s) of personal salary support Career contributions What are your most important research-related contributions to your field to date? These may include contributions to health policy or practice, or to technology or product discovery and development. (350 words max.) Peer-reviewed publications and other research outputs List up to 20 of your most significant peer-reviewed publications, preprints, or other scholarly research outputs, e.g. patents. Please ensure that at least five of these are from the last five years. For 10 of these outputs, you may also provide a statement describing their significance (up to 50 words per output). Please give citation in full, including title of paper and all authors*. Citations to preprints should state Preprint, the repository name and the articles persistent identifier (e.g DOI). (*All authors, unless more than 10, in which case please use et al, ensuring that your position as author remains clear.) Page 2 of 7
Total number of peer-reviewed publications which you have authored/coauthored. Please exclude abstracts and literature reviews. Current and recent research funding (including Wellcome Trust grants) Please list all held in the last five years and any key prior grants (list the most recent first). State the name of the awarding body, name(s) of grantholder(s), title of project, amounts awarded, your role in the project, and start and end dates of support. For all active grants, indicate the number of hours per week that are spent on each project. Applicants 1 Applicant Full Name Department Division Organisation Address Line 1 City/Town Postcode Country Telephone No. Email Address Career history (current/most recent first) From To Position Organisation Education/training From To Qualification Subject Organisation Page 3 of 7
Source(s) of personal salary support Career contributions What are your most important research-related contributions to your field to date? These may include contributions to health policy or practice, or to technology or product discovery and development. (350 words max.) Peer-reviewed publications and other research outputs List up to 20 of your most significant peer-reviewed publications, preprints, or other scholarly research outputs, e.g. patents. Please ensure that at least five of these are from the last five years. For 10 of these outputs, you may also provide a statement describing their significance (up to 50 words per output). Please give citation in full, including title of paper and all authors*. Citations to preprints should state Preprint, the repository name and the articles persistent identifier (e.g DOI). (*All authors, unless more than 10, in which case please use et al, ensuring that your position as author remains clear.) Total number of peer-reviewed publications which you have authored/coauthored. Please exclude abstracts and literature reviews. Current and recent research funding (including Wellcome Trust grants) Please list all held in the last five years and any key prior grants (list the most recent first). State the name of the awarding body, name(s) of grantholder(s), title of project, amounts awarded, your role in the project, and start and end dates of support. For all active grants, indicate the number of hours per week that are spent on each project. Page 4 of 7
Details of proposal Summary Summarise the equipment, resource or technology requested. (200 words max.) Outline the community need for the resource/technology/multi-user item of equipment Please list the names of potential users (including applicants) and indicate how the resource/technology/multi-user equipment will enhance their research. For non-applicants, please also state employing organisation and main sources of funding.* *The Trust anticipates that items of multi-user equipment will be used primarily, but not exclusively, by Trust-funded researchers. Where a significant proportion of users of the equipment are not Trust-funded, we would expect applicants to consider seeking appropriate financial contributions from alternative sources, including other funding bodies. (300 words max.) Unmet need Provide details of similar resources/technologies/items of equipment that are available to you (specifically for equipment, available either locally or nationally) and describe the unmet need(s) that this proposal will address. (300 words max.) Management Briefly describe how the equipment, resource or technology will be managed and plans for long term sustainability. (300 words max.) Page 5 of 7
Related applications Is this a resubmission of an application submitted to the Trust within the last 24 months? Please describe how this application differs from the original (200 words max.) Approximate costs Currency requested Please select the currency requested for award Biomedical Resource and Technology Development applicants only: Summary of financial support requested Please provide an approximate budget for the proposal. The figures provided should reflect the costs being requested from the Trust only, and should not include contributions from other sources. Salaries Materials and consumables Animals Equipment Miscellaneous (including travel costs) Total () Multi-user Equipment applicants only: Summary of financial support requested Please provide an approximate budget for the proposal. The figures provided should reflect the costs being requested from the Trust only, and should not include contributions from other sources. Salaries Equipment Miscellaneous Page 6 of 7
Total () Technology Development and Multi-user Equipment applicants only: Contributions Please list all financial contributions, or equivalent, provided by the host organisation or other sources. Please refer to guidance notes. Contributor Details of contribution Value Currency - Brief justification for financial support requested For example, where salary support is requested, detail the types of posts that these costs relate to (200 words max.) Institutional support Supporting statement from host organisation Please attach a supporting statement from the host organisation, signed by an appropriate senior authority, indicating the contributions, financial or otherwise, that will be provided by the organisation and/or other sources, if appropriate. For biomedical resource grant applications, please ensure that the statement demonstrates the host organisation s commitment to the longer-term sustainability of the resource. For multi-user equipment grant applications, please ensure that the statement includes an indication as to how the request for equipment fits with the overall strategic context of the organisation, taking into consideration regional and national contexts, if appropriate. Please note that letters of support, other than that requested above, will not be included with your preliminary application for consideration by the Committee. It is important therefore to ensure that all essential information is included within the preliminary application form. Page 7 of 7