TRAUMA AND DISASTER
MANAGEMENT (TRADIM)
RESEARCH GRANTS
2017 APPLICATION FORM
1. SMALL GRANTS
2.
PROJECT GRANT
CLOSING DATE: 5:00 pm Monday 8 August 2016
SMALL GRANTS ($20,000) provide seed funding for research studies that have the potential to build
capacity. Applicants should demonstrate the potential for the research to improve health outcomes through
evidence based practice. Two grants will be available.
The PROJECT GRANT ($50,000) provides stand-alone support for a defined project that demonstrates
potential for the research outcomes to be translated into improved health outcomes through evidence based
practice, and/or result in future national or international grants. One grant will be available.
Trauma and Disaster Management Research Grant Scheme
Page i
APPLICATION INSTRUCTIONS
Refer to the Trauma and Disaster Management (TRADIM) Research Grant Funding Guidelines for funding
commencing in 2017 document when preparing your application.
The application MUST be prepared using the supplied application form. Complete all sections as incomplete
applications may not be considered.
Press <Tab> to move between fields.
The applicant is required to sign the application on behalf of the research team.
SUBMISSION
Applications must be submitted electronically to [email protected]:
1.
A signed copy of the application to be submitted as a PDF,
2.
The application must also be submitted in Word format (signatures not required).
Files must not exceed 2 MB in size and should be named using the following naming convention:
Applicant Surname_2017 TRADIM Funding type*
E.g., Smith_2017 TRADIM Small
*Funding types – Small, Project
APPLICATIONS MUST BE RECEIVED BY THE CENTRES FOR HEALTH RESEARCH
NO LATER THAN 5:00 PM MONDAY 8
AUGUST 2016
LATE OR INCOMPLETE APPLICATIONS WILL NOT BE ACCEPTED
ENQUIRIES
Enquiries regarding the TRADIM Research Grant Scheme should be directed to:
PAH Research Grants Administration Officer
Email: [email protected]
Trauma and Disaster Management Research Grant Scheme
Page ii
TRADIM RESEARCH GRANTS
2017 APPLICATION FORM
RESEARCH GRANT APPLICATION TYPE
Small Grant
Project Grant
PROJECT TITLE
(Maximum 200 characters including spaces)
INVESTIGATIVE TEAM
The Applicant must be the Principal Investigator (PI). Up to 4 Co-Investigators (CIs) and 2 Associate
Investigators (AIs) may be included.
Title
Name
Health
Profession
Organisation
PI
Click to choose
First name Surname
Click to choose
Click to choose
CI1
Click to choose
First name Surname
Click to choose
Click to choose
CI2
Click to choose
First name Surname
Click to choose
Click to choose
CI3
Click to choose
First name Surname
Click to choose
Click to choose
CI4
Click to choose
First name Surname
Click to choose
Click to choose
AI1
Click to choose
First name Surname
Click to choose
Click to choose
AI2
Click to choose
First name Surname
Click to choose
Click to choose
OFFICE USE ONLY
APPLICATION NUMBER:
TRADIM
2
0
1
7
Trauma and Disaster Management Research Grant Scheme
Applicant:
ELIGIBILITY CHECKLIST
To be eligible for a 2017 TRADIM Small or Project Research Grant, the Applicant must be
able to answer:
YES
NO
 YES to questions 1-5
 NO to question 6
1
Are you a member of staff of Metro South Health, Royal Darwin Hospital or the
NCCTRC?
2
Will you be employed in the above appointment at least 0.5 FTE for the duration of the
grant?
3
Will the majority (more than 50%) of the research take place:
1.
Within a Metro South Health Site?
2.
At the Royal Darwin Hospital?
3.
In a NCCTRC-approved partnership service facility or organisation within
Queensland or the Northern Territory?
If iii, provide details of the NCCTRC-approved partner service facility or organisation
in the space provided below.
4
Is at least one member of the investigative team a medical doctor, nurse or allied
health professional?
5
Does the investigative team contain a member of staff from Metro South Health
Service OR the Royal Darwin Hospital or NCCTRC?
6
Is the proposed research activity currently funded through an award type currently
listed on the Australian Competitive Grants Register or international equivalent?
Details of NCCTRC-approved partner service facility/organisation
If you answered YES to Question 3iii above, provide details of the NCCTRC-approved partnership service
facility or organisation including location, who approved the service facility/organisation and when it was
approved (maximum 300 characters including spaces).
Eligibility Certification
I, [First Name, Surname], certify that I meet the relevant eligibility criteria for the TRADIM Research Grant
Scheme.
Signature of Applicant: ____________________________________________ Date:
If you have questions concerning your eligibility for the TRADIM Research Grant Scheme, contact
PAH Research Grants Administration Officer
Email: [email protected]
TRADIM Research Grant Application
Page 2
Trauma and Disaster Management Research Grant Scheme
1.
PRINCIPAL INVESTIGATOR (APPLICANT)
1.1.
PI CONTACT DETAILS
PI name
Applicant:
Click to choose First Name Surname
Position
Organisational Department
Department name
Phone numbers
Primary:
Secondary:
Email address
Postal Address
Address line 1
Address line 2
Address line 3
Suburb and Postcode
1.2.
PI ACADEMIC QUALIFICATIONS
Qualification
Awarding Institution
Date
DD/MM/YEAR
DD/MM/YEAR
DD/MM/YEAR
DD/MM/YEAR
1.3.
PARTICIPATION
Summarise your participation in the broad research plan proposed in this application (maximum 300
characters including spaces)
1.4.
PI RESEARCH TIME
Expected 2016 time allocation to:
This study (hr/wk):
Do you expect to have an extended period of absence during 2016?
If Yes, provide expected dates
Other studies (hr/wk):
Yes
No
DD/MM/YEAR - DD/MM/YEAR
Reason
(300 characters
including spaces)
1.5.
PI PUBLICATIONS
List publications produced in the last 5 years with List ALL authors provided
 Indicate publications relevant to this application with an asterisk (*)
 Press <Enter> after each publication to maintain the numbering system
1.
1.6.
PI GRANTS
Provide details of research funding received in the last 5 years and indicate whether the funding relates to
the proposed research of this application
If there is insufficient space in the below table just include the most relevant grants to this application.
TRADIM Research Grant Application
Page 3
Trauma and Disaster Management Research Grant Scheme
Funding body and type
Applicant:
Start date
End date
Amount
Relevant to this
application?
[DD/MM/YYYY]
$
Yes
[DD/MM/YYYY]
[DD/MM/YYYY]
No
$
[DD/MM/YYYY]
[DD/MM/YYYY]
No
$
[DD/MM/YYYY]
[DD/MM/YYYY]
$
$
$
$
$
$
$
$
$
$
$
$
$
[DD/MM/YYYY]
TRADIM Research Grant Application
Yes
No
$
[DD/MM/YYYY]
[DD/MM/YYYY]
Yes
No
[DD/MM/YYYY]
[DD/MM/YYYY]
Yes
No
[DD/MM/YYYY]
[DD/MM/YYYY]
Yes
No
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[DD/MM/YYYY]
Yes
No
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Yes
No
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Yes
No
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Yes
No
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Yes
No
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Yes
No
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[DD/MM/YYYY]
Yes
No
[DD/MM/YYYY]
[DD/MM/YYYY]
Yes
No
[DD/MM/YYYY]
[DD/MM/YYYY]
Yes
No
[DD/MM/YYYY]
[DD/MM/YYYY]
Yes
No
[DD/MM/YYYY]
[DD/MM/YYYY]
Yes
Yes
No
$
Yes
No
Page 4
Trauma and Disaster Management Research Grant Scheme
2.
2.1.
Applicant:
CO-INVESTIGATOR 1
CI1 CONTACT DETAILS
CI1 Name
Click to choose First Name Surname
Position
Organisation and Department
Organisation and Department name
Phone number
Email address
2.2.
CI1 ACADEMIC QUALIFICATIONS
Qualification
Institution
Date
DD/MM/YEAR
DD/MM/YEAR
DD/MM/YEAR
DD/MM/YEAR
2.3.
CI1 PARTICIPATION
Summarise the role of CI1 in the broad research plan proposed in this application (maximum 300 characters
including spaces)
2.4.
CI1 RESEARCH TIME
Expected 2016 time allocation to:
This study (hr/wk):
Does CI1 expect to have an extended period of absence during
2016?
If Yes, provide expected dates
Other studies (hr/wk):
Yes
No
DD/MM/YEAR - DD/MM/YEAR
Reason
(300 characters
including spaces)
2.5.
CI1 PUBLICATIONS
List CI1 publications produced in the last 5 years with List ALL authors provided
 Indicate publications relevant to this application with an asterisk (*)
 Press <Enter> after each publication to maintain the numbering system
1.
2.6.
CI1 GRANTS
Provide details of research funding received by CI1 in the last 5 years and indicate whether the funding
relates to the proposed research of this application
If there is insufficient space in the below table just include the most relevant grants to this application.
TRADIM Research Grant Application
Page 5
Trauma and Disaster Management Research Grant Scheme
Funding body and type
Applicant:
Start date
End date
Funding
Amount
Relevant to this
application?
[DD/MM/YYYY]
$
Yes
[DD/MM/YYYY]
[DD/MM/YYYY]
No
$
[DD/MM/YYYY]
[DD/MM/YYYY]
No
$
[DD/MM/YYYY]
[DD/MM/YYYY]
$
$
$
$
$
$
$
$
$
$
$
$
$
[DD/MM/YYYY]
TRADIM Research Grant Application
Yes
No
$
[DD/MM/YYYY]
[DD/MM/YYYY]
Yes
No
[DD/MM/YYYY]
[DD/MM/YYYY]
Yes
No
[DD/MM/YYYY]
[DD/MM/YYYY]
Yes
No
[DD/MM/YYYY]
[DD/MM/YYYY]
Yes
No
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[DD/MM/YYYY]
Yes
No
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[DD/MM/YYYY]
Yes
No
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Yes
No
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Yes
No
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Yes
No
[DD/MM/YYYY]
[DD/MM/YYYY]
Yes
No
[DD/MM/YYYY]
[DD/MM/YYYY]
Yes
No
[DD/MM/YYYY]
[DD/MM/YYYY]
Yes
No
[DD/MM/YYYY]
[DD/MM/YYYY]
Yes
No
[DD/MM/YYYY]
[DD/MM/YYYY]
Yes
Yes
No
$
Yes
No
Page 6
Trauma and Disaster Management Research Grant Scheme
3.
3.1.
Applicant:
CO-INVESTIGATOR 2
CI2 CONTACT DETAILS
CI2 Name
Click to choose First Name Surname
Position
Organisation and Department
Organisation and Department name
Phone number
Email address
3.2.
CI2 ACADEMIC QUALIFICATIONS
Qualification
Institution
Date
DD/MM/YEAR
DD/MM/YEAR
DD/MM/YEAR
DD/MM/YEAR
3.3.
CI2 PARTICIPATION
Summarise the role of CI2 in the broad research plan proposed in this application (maximum 300 characters
including spaces)
3.4.
CI2 RESEARCH TIME
Expected 2016 time allocation to:
This study (hr/wk):
Does CI2 expect to have an extended period of absence during
2016?
If Yes, provide expected dates
Other studies (hr/wk):
Yes
No
DD/MM/YEAR - DD/MM/YEAR
Reason
(300 characters
including spaces)
3.5.
CI2 PUBLICATIONS
List CI2 publications produced in the last 5 years with List ALL authors provided
 Indicate publications relevant to this application with an asterisk (*)
 Press <Enter> after each publication to maintain the numbering system
1.
3.6.
CI2 GRANTS
Provide details of research funding received by CI2 in the last 5 years and indicate whether the funding
relates to the proposed research of this application
If there is insufficient space in the below table just include the most relevant grants to this application.
TRADIM Research Grant Application
Page 7
Trauma and Disaster Management Research Grant Scheme
Funding body and type
Applicant:
Start date
End date
Funding
Amount
Relevant to this
application?
[DD/MM/YYYY]
$
Yes
[DD/MM/YYYY]
[DD/MM/YYYY]
No
$
[DD/MM/YYYY]
[DD/MM/YYYY]
No
$
[DD/MM/YYYY]
[DD/MM/YYYY]
$
$
$
$
$
$
$
$
$
$
$
$
$
[DD/MM/YYYY]
TRADIM Research Grant Application
Yes
No
$
[DD/MM/YYYY]
[DD/MM/YYYY]
Yes
No
[DD/MM/YYYY]
[DD/MM/YYYY]
Yes
No
[DD/MM/YYYY]
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Yes
No
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Yes
No
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Yes
No
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Yes
No
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Yes
No
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Yes
No
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Yes
No
[DD/MM/YYYY]
[DD/MM/YYYY]
Yes
No
[DD/MM/YYYY]
[DD/MM/YYYY]
Yes
No
[DD/MM/YYYY]
[DD/MM/YYYY]
Yes
No
[DD/MM/YYYY]
[DD/MM/YYYY]
Yes
No
[DD/MM/YYYY]
[DD/MM/YYYY]
Yes
Yes
No
$
Yes
No
Page 8
Trauma and Disaster Management Research Grant Scheme
4.
4.1.
Applicant:
CO-INVESTIGATOR 3
CI3 CONTACT DETAILS
CI3 Name
Click to choose First Name Surname
Position
Organisation and Department
Organisation and Department name
Phone number
Email address
4.2.
CI3 ACADEMIC QUALIFICATIONS
Qualification
Institution
Date
DD/MM/YEAR
DD/MM/YEAR
DD/MM/YEAR
DD/MM/YEAR
4.3.
CI3 PARTICIPATION
Summarise the role of CI3 in the broad research plan proposed in this application (maximum 300 characters
including spaces)
4.4.
CI3 RESEARCH TIME
Expected 2016 time allocation to:
This study (hr/wk):
Does CI3 expect to have an extended period of absence during
2016?
If Yes, provide expected dates
Other studies (hr/wk):
Yes
No
DD/MM/YEAR - DD/MM/YEAR
Reason
(300 characters
including spaces)
4.5.
CI3 PUBLICATIONS
List CI3 publications produced in the last 5 years with List ALL authors provided
 Indicate publications relevant to this application with an asterisk (*)
 Press <Enter> after each publication to maintain the numbering system
1.
4.6.
CI3 GRANTS
Provide details of research funding received by CI3 in the last 5 years and indicate whether the funding
relates to the proposed research of this application
If there is insufficient space in the below table just include the most relevant grants to this application.
TRADIM Research Grant Application
Page 9
Trauma and Disaster Management Research Grant Scheme
Funding body and type
Applicant:
Start date
End date
Funding
Amount
Relevant to this
application?
[DD/MM/YYYY]
$
Yes
[DD/MM/YYYY]
[DD/MM/YYYY]
No
$
[DD/MM/YYYY]
[DD/MM/YYYY]
No
$
[DD/MM/YYYY]
[DD/MM/YYYY]
$
$
$
$
$
$
$
$
$
$
$
$
$
[DD/MM/YYYY]
TRADIM Research Grant Application
Yes
No
$
[DD/MM/YYYY]
[DD/MM/YYYY]
Yes
No
[DD/MM/YYYY]
[DD/MM/YYYY]
Yes
No
[DD/MM/YYYY]
[DD/MM/YYYY]
Yes
No
[DD/MM/YYYY]
[DD/MM/YYYY]
Yes
No
[DD/MM/YYYY]
[DD/MM/YYYY]
Yes
No
[DD/MM/YYYY]
[DD/MM/YYYY]
Yes
No
[DD/MM/YYYY]
[DD/MM/YYYY]
Yes
No
[DD/MM/YYYY]
[DD/MM/YYYY]
Yes
No
[DD/MM/YYYY]
[DD/MM/YYYY]
Yes
No
[DD/MM/YYYY]
[DD/MM/YYYY]
Yes
No
[DD/MM/YYYY]
[DD/MM/YYYY]
Yes
No
[DD/MM/YYYY]
[DD/MM/YYYY]
Yes
No
[DD/MM/YYYY]
[DD/MM/YYYY]
Yes
No
[DD/MM/YYYY]
[DD/MM/YYYY]
Yes
Yes
No
$
Yes
No
Page 10
Trauma and Disaster Management Research Grant Scheme
5.
5.1.
Applicant:
CO-INVESTIGATOR 4
CI4 CONTACT DETAILS
CI4 Name
Click to choose First Name Surname
Position
Organisation and Department
Organisation and Department name
Phone number
Email address
5.2.
CI4 ACADEMIC QUALIFICATIONS
Qualification
Institution
Date
DD/MM/YEAR
DD/MM/YEAR
DD/MM/YEAR
DD/MM/YEAR
5.3.
CI4 PARTICIPATION
Summarise the role of CI4 in the broad research plan proposed in this application (maximum 300 characters
including spaces)
5.4.
CI4 RESEARCH TIME
Expected 2016 time allocation to:
This study (hr/wk):
Does CI4 expect to have an extended period of absence during
2016?
If Yes, provide expected dates
Other studies (hr/wk):
Yes
No
DD/MM/YEAR - DD/MM/YEAR
Reason
(300 characters
including spaces)
5.5.
CI4 PUBLICATIONS
List CI4 publications produced in the last 5 years with List ALL authors provided
 Indicate publications relevant to this application with an asterisk (*)
 Press <Enter> after each publication to maintain the numbering system
1.
5.6.
CI4 GRANTS
Provide details of research funding received by CI4 in the last 5 years and indicate whether the funding
relates to the proposed research of this application
If there is insufficient space in the below table just include the most relevant grants to this application.
TRADIM Research Grant Application
Page 11
Trauma and Disaster Management Research Grant Scheme
Funding body and type
Applicant:
Start date
End date
Funding
Amount
Relevant to this
application?
[DD/MM/YYYY]
$
Yes
[DD/MM/YYYY]
[DD/MM/YYYY]
No
$
[DD/MM/YYYY]
[DD/MM/YYYY]
No
$
[DD/MM/YYYY]
[DD/MM/YYYY]
$
$
$
$
$
$
$
$
$
$
$
$
$
[DD/MM/YYYY]
TRADIM Research Grant Application
Yes
No
$
[DD/MM/YYYY]
[DD/MM/YYYY]
Yes
No
[DD/MM/YYYY]
[DD/MM/YYYY]
Yes
No
[DD/MM/YYYY]
[DD/MM/YYYY]
Yes
No
[DD/MM/YYYY]
[DD/MM/YYYY]
Yes
No
[DD/MM/YYYY]
[DD/MM/YYYY]
Yes
No
[DD/MM/YYYY]
[DD/MM/YYYY]
Yes
No
[DD/MM/YYYY]
[DD/MM/YYYY]
Yes
No
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[DD/MM/YYYY]
Yes
No
[DD/MM/YYYY]
[DD/MM/YYYY]
Yes
No
[DD/MM/YYYY]
[DD/MM/YYYY]
Yes
No
[DD/MM/YYYY]
[DD/MM/YYYY]
Yes
No
[DD/MM/YYYY]
[DD/MM/YYYY]
Yes
No
[DD/MM/YYYY]
[DD/MM/YYYY]
Yes
No
[DD/MM/YYYY]
[DD/MM/YYYY]
Yes
Yes
No
$
Yes
No
Page 12
Trauma and Disaster Management Research Grant Scheme
6.
6.1.
Applicant:
ASSOCIATE-INVESTIGATOR 1
AI1 CONTACT DETAILS
AI1 Name
Click to choose First Name Surname
Position
Organisation and Department
Organisation and Department name
Phone number
Email address
6.2.
AI1 ACADEMIC QUALIFICATIONS
Qualification
Institution
Date
DD/MM/YEAR
DD/MM/YEAR
DD/MM/YEAR
DD/MM/YEAR
6.3.
AI1 PARTICIPATION
Summarise the role of AI1 in the broad research plan proposed in this application (maximum 300 characters
including spaces)
TRADIM Research Grant Application
Page 13
Trauma and Disaster Management Research Grant Scheme
7.
7.1.
Applicant:
ASSOCIATE-INVESTIGATOR 2
AI2 CONTACT DETAILS
AI2 Name
Click to choose First Name Surname
Position
Organisation and Department
Organisation and Department name
Phone number
Email address
7.2.
AI2 ACADEMIC QUALIFICATIONS
Qualification
Institution
Date
DD/MM/YEAR
DD/MM/YEAR
DD/MM/YEAR
DD/MM/YEAR
7.3.
AI2 PARTICIPATION
Summarise the role of AI2 in the broad research plan proposed in this application (maximum 300 characters
including spaces)
TRADIM Research Grant Application
Page 14
Trauma and Disaster Management Research Grant Scheme
8.
8.1.
Applicant:
RESEARCH PROPOSAL
KEY WORDS
Provide up to keywords that best describe the field of research
Keyword 1
Keyword 2
Keyword 3
Keyword 4
Keyword 5
Keyword 6
8.2.
AIMS & HYPOTHESIS
(Maximum 1,000 characters including spaces)
8.3.
RESEARCH SIGNIFICANCE
Describe the expected outcomes and benefits of the proposed study (maximum 650 characters including
spaces)
8.4.
RESEARCH PROPOSAL
Provide the research proposal on the following pages. Include background, research plan and references
(maximum 4 pages including references)
NOTE: The following must be used when preparing your research proposal:
 Arial font with a minimum size of 11 point (including tables, table legends and figure legends)
 Line spacing of 1.5 lines
 Page margins of 2 cm on all sides
DO NOT alter headers or footers
TRADIM Research Grant Application
Page 15
Trauma and Disaster Management Research Grant Scheme
Applicant:
Delete this text and insert the research proposal here
Note: You can format the Research Proposal by selecting Headings, etc., in the Styles (accessible
on MSWord Toolbar).
TRADIM Research Grant Application
Page 16
Trauma and Disaster Management Research Grant Scheme
8.5.
Applicant:
BUDGET
Item
Description
Amount
Personnel/Salaries
$
Maintenance
(consumable items to
be purchased)
$
Equipment
$
Other
(computers will not be
funded)
$
Total
$
Budget Justification
9.
(maximum 1,000 characters including spaces)
OTHER SUBMITTED GRANT APPLICATIONS
Provide details of grant applications related to this study submitted to other funding bodies in the current year
Funding Body
Project Title
Budget
$
$
$
$
$
$
TRADIM Research Grant Application
Page 17
Trauma and Disaster Management Research Grant Scheme
Applicant:
10. REVIEWERS
As outlined in the Funding Guidelines (section 3: Eligibility), three eligible reviewers
must be nominated. For nominations to be eligible, the Applicant must be able to
answer Yes to questions.
1
Are all nominated reviewers external to MSH, the RDH and all service
facilities/organisations with which the investigative team are associated?
2
Is at least one nominated reviewer from interstate or overseas?
3
Are all three nominated reviewers an acknowledged expert in the field (i.e. publication
track record, PhD or equivalent research experience)?
4
Are all three nominated reviewers completely independent of the investigative team
and without conflict of interest? (See section 4.1 of the 2016 Funding Guidelines)
5
Have all three nominated reviewers agreed to be available from mid-August to midOctober to assess your application?
YES
NO
10.1. REVIEWER 1
Name
Click to choose First Name Surname
Health Profession
Click to choose
Organisation/Institution
Organisation/Institution name
Department
Department name
Phone number:
Availability confirmed?
Email:
Yes
No
Comments (100 characters)
Who contacted this reviewer?
10.2. REVIEWER 2
Name
Click to choose First Name Surname
Health Profession
Click to choose
Organisation/Institution
Organisation/Institution name
Department
Department name
Phone number:
Availability confirmed?
Email:
Yes
No
Comments (100 characters)
Who contacted this reviewer?
TRADIM Research Grant Application
Page 18
Trauma and Disaster Management Research Grant Scheme
Applicant:
10.3. REVIEWER 3
Name
Click to choose First Name Surname
Health Profession
Click to choose
Organisation/Institution
Organisation/Institution name
Department
Department name
Phone number:
Email:
Availability confirmed?
Yes
No
Comments (100 characters)
Who contacted this reviewer?
11. EXCLUDED REVIEWERS
If relevant, list details of up to two reviewers you would like excluded from assessing your application and
provide justification for their exclusion
11.1. EXLUDED REVIEWER 1
Name
Click to choose First Name Surname
Health Profession
Click to choose
Organisation/Institution
Organisation/Institution name
Department
Department name
Justification
Provide details
11.2. EXLUDED REVIEWER 2
Name
Click to choose First Name Surname
Health Profession
Click to choose
Organisation/Institution
Organisation/Institution name
Department
Department name
Justification
Provide details
12. HUMAN EXPERIMENTATION
Refer to the National Health and Medical Research Council’s National Statement on Ethical Conduct in
Human Research (2007 updated March 2014)
Human Ethics
YES
NO
Does the project involve research on human subjects?
Has ethical clearance been granted by a Human Research Ethics Committee?
If YES:
1.
Provide the HREC reference number:
2.
Submit the clearance letter with your application
If NO, has a human ethics application been submitted?
NOTE: Funding of a successful application is conditional upon ethical approval of the proposed research.
Notification of ethical approval obtained after submission of this application must be sent to [email protected].
TRADIM Research Grant Application
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Trauma and Disaster Management Research Grant Scheme
Applicant:
13. AGREEMENTS AND CERTIFICATION OF SUPPORT
13.1. CERTIFICATION BY THE PRINCIPAL INVESTIGATOR
I, [First Name, Surname], certify that written agreement (such as an email) has been obtained from all
investigators named in this application and that all provided details are correct.
I understand that should this application be successful, all named Investigators on this application will be
required to sign the Acceptance of Offer.
On behalf of the investigative team, I accept and agree to comply with the ethical standards as set out by the
National Health and Medical Research Committee, and any additional standards required by the Human
Research Ethics Committee. I certify that research will not commence until all ethics approvals, if required,
have been obtained.
Signature of Applicant: ____________________________________________ Date: _________________
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Trauma and Disaster Management Research Grant Scheme
Applicant:
13.2. CERTIFICATION BY HEAD(S) OF DIVISION/DEPARTMENT
I, [First Name, Surname], certify that:
 The proposed research is appropriate to the general facilities in my Division/Department and that I am
prepared to have the project carried out in my Division/Department
 Experiments involving human subjects/animals conform to the general principles set out in the National
Health and Medical Research Committee’s National Statement on Ethical Conduct in Human Research.
Name: ________________________________________________________________________________
Position: ______________________________________________________________________________
Signature: ______________________________________________________ Date: ________________
Name of MSH site/university school: ________________________________________________________
Name of Head of Department/Division: ______________________________________________________
Name: ________________________________________________________________________________
Position: ______________________________________________________________________________
Signature: ______________________________________________________ Date: ________________
Name of MSH site/university school: ________________________________________________________
Name of Head of Department/Division: ______________________________________________________
Name: ________________________________________________________________________________
Position: ______________________________________________________________________________
Signature: ______________________________________________________ Date: ________________
Name of MSH site/university school: ________________________________________________________
Name of Head of Department/Division: ______________________________________________________
TRADIM Research Grant Application
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