ࡱ> '` H8bjbjDD g>&&8_$,PD,Х4:ԧ 4|@$h)Ld-dh^ĥ `D~MF<0u/\u(u4| dnddX,,,,,,,,,  Please complete: Application for grant greater than 15,000 % Application for grant greater than 50,000 % Research Grant Application Form 1. Applicants: The principal applicant is normally the corresponding applicant. If correspondence should be addressed to another applicant, please state this. If there are more than four applicants, please attach details on a separate page. Principal ApplicantApplicant 2Applicant 3Applicant 4SurnameForename(s)AgeTitlePost heldNumber of hours per week on project 2a) Institution/Authority (administering grant if approved): Address at which work will be conducted: Is the host institution/authority willing to support this application Yes ( No ( Title of Investigation: Summary information: a. Proposed start dateb. Duration (in months)c. Total funding requested 5. Research Summaries: a) Scientific Abstract (not to exceed 250 words) please also enclose further details of the project [up to 6 sides of A4 and up to 4 A4 pages of other supporting documents]. b) Please state clearly the aims and objectives of your study. c) What is your study design? d) Summary of research proposal for the layperson (not to exceed 250 words). Please include a brief outline of the clinical benefit / potential value of this you will need to refer to this when discussing outcomes of the project in your annual and/or final report. 6a) Summary of support requested: Project Year 1 Project Year 2 Project Year 3  Total StaffConsumablesTravel and SubsistenceExceptional itemsEquipmentGrand Total b) Breakdown of costs by financial year (1 April to 31 March): Financial Year 1 Financial Year 2 Financial Year 3 Total StaffConsumablesTravel and SubsistenceExceptional itemsEquipmentGrand Total UCARE relies on donations and therefore, grants for 3 years will be agreed in principle, and will be subject to satisfactory annual review the ability of UCARE to fund the subsequent years. 7. Does this project involve the use of human participants or human tissue? Yes ( No ( UCARE will consider applications before ethics committee approval is obtained, but expects a copy of the ethics, MHRA [if applicable] and all approval letter within six months of notification of grant award and before funds will be released. 8. Other research grants and grant applications a) Is this application currently being submitted elsewhere? Yes ( No ( If yes, to which organisation, and by what date is a decision expected? b) Has this, or a similar application been submitted elsewhere over the past year? Yes ( No ( If yes, to which organisation, and what was the result? c) Do you hold, or are you currently applying for another research grant(s) on a similar or related topic? Yes ( No ( If yes, please give details, and explain if this will overlap with your current application to UCARE. d) Is this application a resubmission of an application previously considered by UCARE? Yes ( No ( If yes, please explain briefly stating how this application differs from the original. e) Have you previously held (a) grant(s) from UCARE? Yes ( No ( If yes, please list project titles and start dates along with details of any resulting publications and other outcomes. f) Please list other current grants you hold, including name of awarding body, title of project, amount awarded and dates of support 9. Declaration: Applicants: I have read the Terms and Conditions of UCARE and agree to abide by them. If a grant is made, I will take all reasonable actions to ensure that UCAREs contribution to funding the research is suitably acknowledged in all publications arising from it, and ensure that copies of any such publications are forwarded to the UCARE. will comply with policies on intellectual property rights and commercial exploitation as set out in the Terms and Conditions will inform the Charity of any changes to details set out in the application I shall actively be engaged with the project, and in day-to-day control of the project. To be signed by:SignatureName in block capitalsDate Principal ApplicantApplicant 2Applicant 3Applicant 4 10. This application should be submitted by/through (1) the Head of Department and (2) the Officer who will be responsible for administering any grant that may be awarded. Each should sign the following declaration: I confirm that I have read this application and that, if granted, the work will be accommodated and administered in the Department/Institution in accordance with the terms and conditions of grant awards of UCARE. The staff grades, salaries and other costs quoted are correct and in accordance with the normal practice of this institution. I confirm also that this institution is subject to external audit. Head of DepartmentAdministrative AuthoritySignature: Title: Name and Initials (Block Capitals):Institution: Address: Date: 11. Full official contact details of all applicants Principal applicant Applicant 2Applicant 3Applicant 4Name:Department:Institution:Address: Telephone No:Fax No:Email:  12. Proposed Investigation: Please print (or type) using a standard sized font (no smaller than 10 point) and supply on separate pages using the below 6 headings. DO NOT exceed six pages. Extra pages may be used for the reference list, as well as data tables, graphs, photographs and pilot data where these are included. 1. Title: 2. Purpose: 3. Background: 4. Plan [including methods]: 5. Time lines: 6. Detailed justification for support: 13. Details of support requested broken down by project year (summarised in Section 6) Details of posts by nameGradeStart PointIncre- mental dateStart Salary London weightOtherSuperan and Nat InsTotal costs Yr 1 Research staff 1 2 3 4Technical staff 1 2 3 4 Other staff 1 2Annual Costs of above posts Effort on project per cent monthsYear 1Year 2Year 3TotalResearch staff 1 2 3 4 %monthsTechnical staff 1 2 3 4 %monthsOther staff 1 2%monthsGrand Total: 13. Continued Consumables please specifyYear 1 Year 2 Year 3  Total Animals - purchase UCARE will not support research involving live animals unless there is no alternative, and it is essential to the outcome of the research. 1) Intended source of supply 2) Species and microbiological quality required 3) Number required 4) Purchase price per animal Animals - maintenance Subtotal annual costs Consumables etc. (continued) Please specifyYear 1 Year 2 Year 3  Total Total Annual Costs 13. Continued Travel and subsistence, destination and purposeNumber of journeys/ daysMode of transportFare/ milageSubsistenceFeesTotal Within the UK Overseas Total Annual Costs Year 1Year 2Year 3 UCARE will not normally meet costs associated with travel to conferences. See Guidance. Exceptional ItemsTotal Total Annual Costs Year 1Year 2Year 3 13. Continued Equipment Description of items and country of manufactureExpiry date of quotationLikely Delivery DateBasic Price Import DutyTotal 1 2 3 4 5 6 7 Annual cost of above itemsYear 1Year 2Year 31 2 3 4 5 6 7 Total Annual CostsMedical / scientific equipment purchased with charitable funds, when donated to designated non-profit making (hospital or research) institutions to be used for medical research is zero rated for VAT. VAT should therefore be excluded when applying for equipment costs from the UK and Republic of Ireland. 14. Curriculum Vitae of applicant (please supply a one page CV for each applicant to include the following) Name: Age and Date of birth: Degree etc. (subject, class, university, and date): Posts held (with dates): Recent Publications; also papers in press: Do you have assured salary support for the period of the grant? Yes ( Salary applied for in current proposal ( If neither of the above is true, please explain the circumstances below. Do you have links (eg. consultancies, equity holdings) to companies or other organisations that are relevant in any way to the current proposal? Yes ( No ( If yes, please give details. 15. Experiments involving animals Applicants must have regard to animal welfare and advances in the refinement, replacement and reduction of animal use. UCARE will not support research involving live animals unless there is no alternative, and it is essential to the outcome of the research. If the proposed research project involves research on live animals, their use must be minimised and optimised. The number of animals requested must be fully justified. UCARE emphasises the importance of refining procedures to minimise any pain or distress caused. Please refer to UCAREs policy on the use of live animals before answering these questions: 15.1 Do the experiments you propose involve the use of protected animals in regulated procedures under the Animals (Scientific Procedures) Act 1986? (For the information of non-UK applicants, this includes all vertebrates as well as octopus.) Yes ( No ( If yes, which species and how many animals? Are any of the procedures of substantial severity? Yes ( No ( 15.2 Has a project licence, under the terms of the Animals (Scientific Procedures) Act 1986, been granted which authorises the proposed experiments? Yes ( No ( If yes, please state the name and address of the licensee, Home Office reference and date of issue and attach a copy of the front page of the project licence. If not, has it been applied for? Yes ( No ( Does each individual carrying out work on animals have a personal licence? Yes ( No ( 15.3 Have all those involved in the care and use of animals before, during and after the experiments, received appropriate training in animal care and in the procedures involved? Has this training included attendance at the relevant courses? 15.4 Does your institution have an Ethics (or Animal Care and Use) Committee for animal experiments? If so, have the proposed experiments received its approval? If not, what steps have been taken to gain its approval? If no such committee exists, what alternative measures have you taken? 15.5 Will the animals be conscious for all or part of the experiments? If so, explain why this is necessary, what, if any, discomfort they are likely to experience and how it is ameliorated. 15.6 If the animals are to be anaesthetized, will they be allowed to regain consciousness? Unless the animals are to be the subject of survival studies, explain why this is being allowed. 15.7 Have the appropriate power calculations been performed to determine the number of animals required? If so, please give the calculations. 15.8 Does the proposed experimentation on live animals duplicate any other research which has already taken place, or which is known to be currently taking place in any research establishment? 15.9 Will you be engaging any other establishment to carry out experiments on live animals as part of this research project? If so, please provide full details. 16. Scientific Integrity UCARE expects the highest standards of integrity to be adhered to by researchers whom it funds. Institutions in the UK and Republic of Ireland are required to have in place their own published standards of good research practice and formal written procedures for the investigation of allegations of scientific misconduct. These must comply with the Association of Medical Research Charities Guidelines on Good Research Practice ( HYPERLINK "http://www.amrc.org.uk/temp/AMRCspGuidelinessponspGoodspResearchspPracticehs1hs.doc" http://www.amrc.org.uk/temp/AMRCspGuidelinessponspGoodspResearchspPracticehs1hs.doc). Please attach a copy of your Institutions policy on good research practice/scientific integrity. 17. Dissemination UCARE has a responsibility to ensure that all useful knowledge acquired from research it funds is disseminated to the public and to others able to utilise or benefit from it. Annual and final reports are required which specifically indicate the relevance of research progress and outcomes to Urological Cancer. Grant holders are expected to seek publication of findings in peer reviewed journals as soon as possible, even where results prove negative. UCARE must be notified in advance of publication, and acknowledged in all publications and presentations arising from research it funds. Please outline proposed arrangements for dissemination. 18. Monitoring and Evaluation UCAREs Trustees have a responsibility to ensure that work of the highest quality is produced. UCARE therefore requires that the Host Institution ensures that all funded work is adequately supervised at all times, monitored and evaluated. The results of the research must be subject to proper evaluation before they are published. Grant holders are required to complete an annual report and be familiar with the UCARE terms and conditions of award. Please indicate what other arrangements are in place for monitoring and evaluation: ie your local R&D 19. Collaboration on a research project Any individuals named as collaborators (NOT as applicants) in this research application should complete a copy of this form. Name of principal applicant: Principal applicants department and institution: Name of collaborator: Full address of collaborator, including department and institution: Title of research grant application: Extent and nature of collaboration: 20. UCARE may send your application for external review. 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