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HSE Research Awards on Ageing
Application Form, May 2017
ESSENTIAL INFORMATION FOR APPLICANTS
Please read the Guidance Notes for the 2017 HSE Research Awards on Ageing in FULL before completing this Application. The purpose, objectives, scope and assessment criteria / process for the
Research Awards on Ageing call are outlined in the Guidance Notes
SUBMISSION REQUIREMENTS: Use Arial font, size 11, single line spacing. Ensure word / page count are consistent
with requirements specified Use language that is succinct and comprehensible to a non-expert or lay person Please make sure that any abbreviations used are fully explained Electronic signatures ARE permitted Ensure ALL relevant documentation / signatures are provided as outlined in the
submission checklist overleaf Applications should be submitted by email to: [email protected] no later than Wednesday
6 September 2017 at 12 noon Applicants should note that there may be a time delay in acknowledging receipt of email
applications We recommend that applicants allow a MINIMUM of TWO hours for the application to
be received Applicants will receive an email message to confirm that the application / supporting
documentation has been received
IMPORTANT: A number of appendices are referred to throughout this application – these are
included at the END of the application for your convenience When completing the application, use this document. DO NOT submit the application
as a PDF document Applicants are strongly encouraged to leave plenty of time to complete the application,
the supporting documents and to obtain the required signatures before submission Late or incomplete applications will NOT be considered For any queries about completing this application please email [email protected] by
Friday 25 August 2017. Queries received after this date may not be answered.
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CHECKLIST FOR APPLICANTS
Please ensure you have included all the information required before submitting your application:
Checklist Please tick to confirmYou have fully completed ALL sections of the
Application Form
YES
The Budget / Breakdown of Proposed
Expenses (Appendix 1)
YES
CV Template for the Principal Investigator /
Co-Investigators (Appendix 2)
YES
The Infrastructure Agreement Form
(Appendix 3)
YES
The Project Management GANTT Chart
(Appendix 4)
YES
The Collaborator Agreement Form
(Appendix 5)
YES
CV Template for Newly Recruited Personnel
(Appendix 6)
YES
Host Institution / Organisation letter of support and
stamp of approval
YES
Ethical Approval (IF REQUIRED) YES N/A
OVERVIEW OF THE APPLICATION (Boxes 1- 3)
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1. Proposed research title
Project title
2. Proposed project dates
Start date (can start no earlier than January 2018)
End date(max. 24 months duration)
3. Research project budget (Please complete in Euros (€))(Please note a further breakdown of budget / proposed expenses is required in
Appendix 1)
What is the total cost of delivering the project? €
Amount of budget being sought from the 2017 HSE Research Awards on Ageing
€
Do you have matched* funding for this project?Yes No
If ‘Yes’, for what amount? €
If ‘Yes’, what institution / funding body is providing the matched funding?
*NB: A letter of evidence will be required for shortlisted applications with matched funding
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RESEARCH TEAM AND ENVIRONMENT (Boxes 4 – 14)
4. Lead Applicant: Principal Investigator
Name (including title)PositionWill the Principal Investigator hold a post that covers the duration of the research award?
*If No, please see Section Research Team and Environment of the Guidance Notes
Yes No*
Organisation/Faculty
Address
Work telephone and mobile telephone (Please provide both) Email address
Please complete the CV template for the Principal Investigator / Co-Investigators, Appendix Two, outlining your:
(i) Career profile (max. two pages)(ii) Publications (max. one page)(iii) Successful acquisition of external grant income (max. one page)
5. Co-Investigator Number 1
Name (including title)PositionOrganisation/FacultyAddress
Email address
Please complete the CV template for the Principal Investigator / Co-Investigators Appendix Two, outlining your:
(i) Career profile (max. two pages)(ii) Publications (max. one page)(iii) Successful acquisition of external grant income (max. one page)
6. Co-Investigator Number 2
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Name (including title)PositionOrganisation/FacultyAddress
Email address
Please complete the CV template for the Principal Investigator / Co-Investigators Appendix Two, outlining your:
(i) Career profile (max. two pages)(ii) Publications (max. one page)(iii) Successful acquisition of external grant income (max. one page)
7. Co-Investigator Number 3
Name (including title)PositionOrganisation/FacultyAddress
Email address
Please complete the CV template for the Principal Investigator / Co-Investigators Appendix Two, outlining your:
(i) Career profile (max. two pages)(ii) Publications (max. one page)(iii) Successful acquisition of external grant income (max. one page)
8. Co-Investigator Number 4
Name (including title)PositionOrganisation/FacultyAddress
Email address
Please complete the CV template for the Principal Investigator / Co-Investigators Appendix Two, outlining your:
(i) Career profile (max. two pages)(ii) Publications (max. one page)(iii) Successful acquisition of external grant income (max. one page)
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9. Collaborator Number 1
Name (including title)PositionDisciplineOrganisationAddress
Email address
10. Collaborator Number 2
Name (including title)PositionDisciplineOrganisationAddress
Email address
11. Collaborator Number 3Name (including title)PositionDisciplineOrganisationAddress
Email address
12. Collaborator Number 4Name (including title)PositionDisciplineOrganisationAddress
Email address
13. Collaborator Number 5Name (including title)PositionDisciplineOrganisationAddress
Email address
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14. Infrastructure and Support (max. 300 words)Please describe the infrastructure, facilities and other resources available at the Host Institution/Organisation which will directly support this specific project. Please ensure that the Infrastructure Agreement Form is signed (Appendix 3)
PROJECT APPLICATION (Boxes 15-27)
15. Current knowledge and the research deficit that is being addressed (max. 1200 words excluding references - complete references in Box 35)
Please outline the background to the proposed research, including current evidence and justification of the need for the proposed research. Describe how the proposed research will add new knowledge/understanding and is innovative
16. Project abstract (max. 200 words)
Please provide a short synopsis of the application, to include the background, aim, objectives, methodology, results of feasibility studies if available, and potential policy and practice implications
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17. Aim of project (max. 100 words)
Please state the overall aim of the research project
18. Objectives of project (max. 200 words)
Please state the objectives of the research project (consider developing a minimum of three and no more than five objectives)
19. Deliverables (max. 600 words)
Please describe the deliverables arising from each objective of the project
20.Design and methodological approach (max. 2000 words)Please outline the proposed methodological approach for the project
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21.Stakeholder, inter/multidisciplinary and cross-sectoral collaborations (max. 300 words)
Please indicate how you will develop productive stakeholder interactions and inter/multidisciplinary research that cuts across sectors. Include the benefits of the collaborations proposed
22.Risks and challenges (max. 300 words)Please outline potential risks, challenges and obstacles in conducting the proposed research and how you intend to address/overcome these
23. Relevance and potential impact (max. 600 words)Please outline the relevance and potential impact of the proposed research on policy, practice and/or service delivery, with reference to the theme of this call
24. Knowledge management (max. 300 words)Please outline the plan for knowledge management including: (1) knowledge translation and (2) knowledge transfer and dissemination
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25. Ethical approvalDoes this application require ethical approval?
Yes No
If ‘Yes’, have you applied for ethical approval? Yes No
If ‘No’, please provide the reason why (for instance if ethical approval is not applicable)If ‘Yes’, please specify the organisation/institution where you have submitted your ethical approval applicationHave you been granted ethical approval? Yes No *
If ‘Yes’, please attach relevant documentation Please scan and submit as an attachment of the
application. For example, SmithHealthService Executive6September2017EthicalApproval
* If ‘No’, please give the reason
26. Ethics (max. 300 words)Please outline your approach to addressing any ethical considerations for the application and how you plan to address them
27. Data protection (max. 300 words)Please demonstrate compliance with relevant data protection legislation in conducting the proposed research
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PROJECT MANAGEMENT AND GOVERNANCE STRUCTURES (Box 28)
28.Project management and governance structures (max. 600 words)Please outline the project management and governance structures for this application. Work packages and budget justification should be outlined. A GANTT chart (Appendix 4) and a budget breakdown (Appendix 1) must also be provided
ROLES AND RESPONSBILITIES OF TEAM MEMBERS (Boxes 29 - 31)
Please see overleaf
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Principal Investigator:
29. Time to be dedicated to this project in total days* by the Principal Investigator with respect to the work packages over the duration of the projectWork Package Number Work Package Tasks Role of Principal
InvestigatorTime to be dedicated to
this project in total days
Total amount of time to be dedicated to this
project as an overall % of your time
12345
Co-Investigators:
30.Time to be dedicated to this project in total days* by the Co-Investigators with respect to the work packages over the duration of the project
Work Package Number
Work Package Tasks
Co-Investigator Name
Role of Co-Investigator
Time to be dedicated to this
project in total days
Total amount of time to be
dedicated to this project as an
overall % of your time
12345
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Collaborators
31.Time to be dedicated to this project in total days* by the Collaborator(s) with respect to the work packages over the duration of the project
Work Package
Work Package Tasks Collab-1Role
Collab-2Role
Collab-3Role
Collab-4Role
Collab-5Role
Time to be dedicated to this project in total days
12345
* One day = eight hours
Please expand these boxes to meet the needs of your project
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32. Personnel newly recruited through the award (max. 300 words)Where you have identified a candidate(s) to undertake this work, please include a CV for each candidate (See Appendix 6). Please indicate the % of time commitment for each newly hired candidate and define their role in the project. Where you have not identified a candidate for the post, please supply a job description (max. 300 words) in the box below
HOST INSTITUTION/ORGANISATION (Box 33)
33. Host Institution/Organisation authorising participation in the awardName, title and position of authorised signatory
Email addressSignature of authorised signatory
Date
Official Organisation Stamp
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DECLARATION AND SIGNATURES OF APPLICANTS (Box 34)
34. Declaration and SignaturesIn submitting this application, including the information provided in the appendices, I confirm that I have read and understood the HSE Research Awards on Ageing guidance notes and confirm that the application complies with all aspects of the guidelines including ethical, data protection, legislation and intellectual property
Name (BLOCK CAPITALS) Signature Date
Principal InvestigatorCo-Investigator 1
Co-Investigator 2
Co-Investigator 3
Co-Investigator 4
Collaborator 1
Collaborator 2
Collaborator 3
Collaborator 4
Collaborator 5
Electronic signatures are permitted
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REFERENCES (Box 35)
35. References in Harvard Style for the literature review (max. 30 references)Please list references cited with respect to the proposed research project
INTERNATIONAL PEER REVIEWERS (Box 36)
You are allowed to indicate a maximum of three individuals who you recommend to review your application and reasons for this. They should be based outside of Ireland. The individuals nominated by you may or may not be contactedName / Position / Organisation / Email
Reasons for nomination
Name / Position / Organisation / Email
Reasons for nomination
Name / Position / Organisation / Email
Reasons for nomination
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APPENDICES
APPENDIX 1: THE BUDGET/BREAKDOWN OF PROPOSED EXPENSES
APPENDIX 2: CV TEMPLATE FOR THE PRINCIPAL INVESTIGATOR / CO – INVESTIGATORS
APPENDIX 3: INFRASTRUCTURE AGREEMENT FORM
APPENDIX 4: PROJECT MANAGEMENT GANTT CHART
APPENDIX 5: COLLABORATOR AGREEMENT FORM
APPENDIX 6: CV TEMPLATE FOR NEWLY RECRUITED STAFF
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APPENDIX 1. THE BUDGET/BREAKDOWN OF PROPOSED EXPENSES ( Please complete this table in Euros)
Description Amount Requested (€)
Staff
Training
Consumables
Travel
Overhead contributions
Other
TOTAL (€)
Staff: Staff costs must be outlined for each salaried member of staff involved in the project and includes the gross annual salary. The salary scale and point on the salary scale to which the candidate will be appointed should be defined. The employer’s PRSI contribution is calculated at 10.75% of the gross salary. The pension contribution will be a maximum of 20% of the gross salary, and should be in line with the host institution’s pension policy for contract staff.
Training: Relevant training courses/workshops for funded research personnel.
Consumables: The upper cost for consumables during the lifetime of the award is €4000. This is inclusive of small items of equipment, typical consumables costs such as stationery, and also includes transcribing and dissemination costs.
Travel: Travel for participants to undertake field work, attend conferences/workshops to disseminate research findings. It is recommended that at least one national and one international event are attended for dissemination purposes.
Overhead contributions: A contribution to overheads of 30% of total direct costs is allowed for each research project, or 25% for desk based research.
Other: Additional categories may be added as ‘other’, providing a clear description of what the funding will be used for, for instance data collection or other similar costs.
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APPENDIX 2. CV TEMPLATE FOR THE PRINCIPAL INVESTIGATOR / CO – INVESTIGATORS (max. four pages)
NAME
ORGANISATION
WORK AND MOBILE TELEPHONE NUMBERCAREER PROFILE (max. two pages)Employment history in the area of research within the last five years, relevant to this application. NB: Principal Investigators please demonstrate your ability to lead a researcher and manage relationships with Co-Investigators, Collaborators and the Host Institution
PUBLICATIONS (max. one page)Please provide examples of your “most impactful” publications in peer-reviewed journals in the last five years (max. five examples). Please highlight in bold articles where you are the lead author
SUCCESSFUL ACQUISITION OF EXTERNAL GRANT INCOME (max. one page)Award Type Start & end date of
awardTitle of the award Amount of
award (€)Describe your role –PI, Co-I, Collaborator
Expand table by adding rows as required (Please DO NOT exceed the page limits)
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APPENDIX 3. INFRASTRUCTURE AGREEMENT FORM
Please describe the nature of the support provided to the research team from the Host Institution/Organisation? (max. 600 words)
Please provide details on any income and/or expenditure related to the research project arising out of support from the Host Institution/Organisation*. Please note that items of expenditure which are being requested from the award budget must also be included in the budget (Appendix 1) of the Application Form.
Category Cost of Support (€) Type of Income/Expenditure**
Overheads***Other
* Please edit the table as necessary to include all categories.** For example, an in-kind contribution, funding requested from project budget, funding leveraged from elsewhere.*** If an overhead is requested as part of securing the services of the Host Institution/Organisation, it must be included within the overall research awards overhead contribution to the project budget. It is the responsibility of the Principal Investigator and the Host Institution/Organisation to establish any sub-agreements as to how the overhead payments from the research awards will be distributed in such a case.
Please provide details and justification for all items listed in the table above (max. 200 words)
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Principal InvestigatorAs the Principal Investigator I confirm, to the best of my knowledge, that the information provided in this application is correctName (BLOCK CAPITALS)Signature
Date
Director or any other person authorised on behalf of the Host Institution/Organisation or equivalent to endorse this agreement. As the Director of the Host Institution/Organisation, or equivalent, I confirm, to the best of my knowledge, that the information provided is correct
Name (BLOCK CAPITALS)Signature
Date
Official Organisation Stamp
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APPENDIX 4. PROJECT MANAGEMENT GANTT CHART
Work package and timelines MonthsWork
PackageNumber
Objective(s) Task Deliverable (s)
1 2 3 4 5 6 7 8 9 10 11 12
12345
Please complete this GANTT chart to meet the needs of your project. Expand columns as required to meet the duration of the project
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APPENDIX 5. COLLABORATOR AGREEMENT FORM
CollaboratorName, institution/company and address
What are the objectives of the collaboration? (max. 150 words)
For industrial collaborator(s), do any of the academic applicants have a direct or indirect interest (consultancy, shareholding, options etc.)? If so, what is the nature of the interest and how are conflicts of interest between the parties being managed? (max. 150 words)
Are there any restrictions on technology transfer, knowledge transfer and/or dissemination of the results from this project arising out of the collaboration? If so, what are these restrictions? (max. 150 words)
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Please provide details on any income and/or expenditure related to the research project arising out of this collaboration*. Please note that items of expenditure which are being requested from the award budget must also be included in the budget (Appendix 1) of the Application Form.
Category Cost of Support (€)
Type of Income/Expenditure** Please provide details and justification for all items listed
ConsumablesExpert Advice * Please edit the table as necessary to include all categories.** For example, an in-kind contribution, funding requested from project budget, funding leveraged from elsewhere.
Up to five Collaborators can be included in the Application.
Please complete a separate Collaborator Agreement Form (Appendix 5) for each Collaborator and paste into this section.
Electronic signatures are permitted.
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APPENDIX 6. CV TEMPLATE FOR NEWLY RECRUITED PERSONNEL (max. one page)
NAME
EDUCATIONPlease include details of post-graduate training relevant to area, awarding body and date
CAREER PROFILEEmployment gained within the last five years relevant to the position
ROLE IN PROJECTPlease include details of key responsibilities and percentage of time to be dedicated to the project
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