HRC REF:
NI: Surname
Form Pacific CDA
Career Development Award Application Form (Pacific CDA)
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Module 1 of the application must be completed on the HRC Gateway to register the application and receive
an HRC Ref ID#.
This form contains the Coversheet, Module 1 section 1B-1F, Module 2, Module 3 and Module 4 sections
4A-4D.
Module 4 contract information and budget file must be completed and uploaded separately (for PhD,
Pacific Health Postdoctoral and Davis Fellowships, with budget spreadsheet .xlsx available on HRC website).
Module 5 contains NI CVs that are uploaded separately.
Module 6 is the research classification of the research that must be completed online.
This form must be downloaded and completed by applicants before being uploaded to the HRC Gateway as a pdf file.
The complete application with all Modules will be generated by the HRC Gateway for downloading and
printing.
Use the Guidelines for details on how to use this form. Information should only be entered into the fields indicated.
COVERSHEET
HRC Ref ID#:
Click here to enter text.
Applicant:
Click here to enter text.
Computer used to complete this form:
Click here to enter PC or MAC
This COVERSHEET is for identification purposes. It will be replaced by the online pages (Module
1) in the final submitted application compiled by the HRC Gateway
(https://gateway.hrc.govt.nz).
Information should only be entered into the fields indicated. Enter the details above before
going to Section 1B.
HRC-Pacific CDA Form ©2017 Health Research Council of New Zealand. All rights reserved.
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Page 1
HRC REF:
NI: Surname
MODULE 1: APPLICANT INFORMATION
Section 1B: Personal Information
Details of Pacific
indigenous descent
Indicate the type of scholarship/award you are applying for
Pacific Health Summer Studentships
Pacific Health Knowledge Translation Grant
Pacific Health Research Masters
Pacific Health Research PhD
Pacific Clinical Research Training Fellowship
Pacific Health Research Postdoctoral Fellowships
Sir Thomas Davis Te Patu Kite Rangi Ariki Health Research Fellowship
Pacific Health Research Preventing and Minimising Gambling Harm Awards
See explanatory notes for descriptions
Will you be employed during your tenure?
Note: the HRC has an expectation that any award will be taken up on a full-time basis. Any
alternative will be assessed on a case-by-case basis. Ensure, if this is the case, that
sufficient justification is detailed below.
If answered Yes, give details
Place of Employment
Hours per week
Justification
Description of applicant’s field of interest
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Overview of research/work previously undertaken by the applicant
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Page 2
Yes/No
HRC REF:
NI: Surname
Section 1C: Career Plans (1-page limit)
For all applicants, describe your background and potential; specifically, describe how the
proposed award supports/relates to your career plans.
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HRC-Pacific CDA Form ©2017 Health Research Council of New Zealand. All rights reserved.
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Page 3
HRC REF:
NI: Surname
Section 1D: Academic and Organisation Support
Provide details of research supervisor/s and / or other investigators on this research if
applicable:
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CRTF applicants should include a letter from their main supervisor stating supervisory and
resource arrangements under this section.
Research Supervisor(s) and/or other Investigators on this research (if applicable)
Title, first name, surname
Role
Institution/Organisation
Reasons for selection of those listed above.
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HRC-Pacific CDA Form ©2017 Health Research Council of New Zealand. All rights reserved.
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Page 4
HRC REF:
NI: Surname
Section 1E: Applicant Academic Transcript
Provide a scan of witnessed signed copy of your academic transcript.
HRC-Pacific CDA Form ©2017 Health Research Council of New Zealand. All rights reserved.
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Page 5
HRC REF:
NI: Surname
Section 1F: NZ Standard CV - Applicant
For Summer Studentships, please provide the CV of the supervisor/s instead. This information
will be used to assess the suitability and expertise of your supervisor/research team in the field
of research you intend to undertake. Provide a CV for each individual, if applicable.
HRC-Pacific CDA Form ©2017 Health Research Council of New Zealand. All rights reserved.
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Page 6
HRC REF:
NI: Surname
Click here to insert applicant CV. All other CVs can be uploaded separately. All details must be
identical to elsewhere on this application. Follow CV Guidelines: no more than 2 pages for Part
1, 3 pages for Part 2. Arial 12-point font, standard margins, delete instructions. List publication
with full authorship.
HRC-Pacific CDA Form ©2017 Health Research Council of New Zealand. All rights reserved.
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Page 7
HRC REF:
NI: Surname
MODULE 2: RESEARCH INFORMATION
Overview of Proposed Research
Use the space below (8-page limit) to describe your research, structured under the headings
below.
Note: Timelines and Key Milestones will be used to form the basis of the contract, if the
application is successful.
Health significance
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Key Milestones and Timelines (use Gantt chart)
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Research Design and Methods
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Māori Health Advancement
Delete these words and start typing here. How has Māori consultation informed your research design? How
might your research contribute to the health needs of Māori? What is the health significance and context of
this research to Māori? Discuss the incidence or prevalence in Māori, or indicate if not known to be
significantly different from the general population. Have you sought advice for the study from a Māori
researcher/representative?
Dissemination of Results
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results will be communicated to ensure knowledge transfer and achieve change.
Potential for Realising Health and Economic Gains for New Zealand
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An indication of Pacific Community and/or Community Linkages and Support for the Research.
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HRC REF:
NI: Surname
MODULE 3: REFERENCES
(1-page limit)
Asterisks are to be placed beside applicants’ publications. Provide references in full and state
full authorship (for example not Smith et al). Endnote lists must be copied into a plain text
editor before pasting in here.
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HRC-Pacific CDA Form ©2017 Health Research Council of New Zealand. All rights reserved.
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HRC REF:
NI: Surname
MODULE 4: BUDGET AND CONTRACT INFORMATION
Section 4A – Contract Information
Host Institution1
Has the Host Institution/Organisation committed to the financial support of this research?
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Complete information below (Postdoctoral and Sir Davis applicants only)
Full name
Title
First name
Second name(s)
Family name
Host Organisation
Qualifications at time of application
Title of award application
Start date and duration
Agreed salary2, $
Agreed grade
Outline costs associated with your study (Summer Studentship, Knowledge Translation Grant, MA applicants only)
Items
Fees
Stipend (total)
Tufungatika Allowance
Other
Total
Costs
Justification of Research Staff (Postdoctoral and Sir Davis applicants only)
Explain and justify the role of personnel, who will be associated with your research including
any supervisors or investigators not funded through this research. These may be research
assistants, technicians, medical staff, interviewers, support staff or similar, who have specific
FTE involvements listed in Section 4F.
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The HRC expects that costs of the research undertaken by scholarship/fellowship recipients over and above that provided by the
award will be borne by the host institution. Applicants should confirm that such resources are in place to ensure the successful
completion of their award. Whilst it is the responsibility of the host institution to bear the cost of the research, this does not
preclude the submission of a proposal in the HRC funding round. Applicants should understand that such funding is contestable and
not guaranteed. The HRC’s contribution to research costs is intended to facilitate the establishment of the scholar/fellows research
programme.
1
2
Note: the salary amount must be the same amount reflected in the budget or the lesser total maybe taken. Any salary variation
after the approval process must be submitted in writing to the HRC and signed by both the applicant and the host institution.
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HRC REF:
NI: Surname
Section 4B – Previous/Current Contracts and Awards
List previous/current contracts awarded to applicant within the past 5 years.
Funding agency
Title of research
Investigators
Start date and duration
Total value
Nature of support
(one sentence)
If HRC contract (HRC Ref #),
was Final Report filed? If not,
why?
Click here to paste in as many copies of the above table as required.
Section 4C – Other Support
Other Research Applications Awaiting Decision
Applicants must advise the HRC of the outcome of other research applications through their
Research Office if known up to October 2017.
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Funding agency
Title of research
Investigators
Start date and duration
Total value
Date of outcome
Areas of overlap with this
Application. HRC Ref #?
Click here to paste in as many copies of the above table as required.
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HRC REF:
NI: Surname
Co-Funding
What other agencies or end-users have been approached or committed to joint or partial
funding of this research?
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Financial Interest(s)
Do you or any named investigator have a financial interest related to the research or
sponsorship of the research?
Delete these words and enter Yes or NO.
If yes, outline below and provide details of your conflict management strategy.
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Section 4D – Letters of Collaboration/Supporting Documents List
List below all MOU or sub-contracts and include copies with the application. All other
documents should be paper-clipped separately with the application and should include the HRC
Reference ID#. Letters of collaboration, which outline material or actual support, can also be
listed. Science Assessing Committee members will see the list below and documents will only be
made available on request.
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Section 4E - 4F Budget and FTE (PhD, Postdoctoral and Sir Davis applicants only)
Upload the completed file for sections 4E-4F. The spreadsheet is available on the HRC
website.
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