Life Sciences Initiative
Community Engagement Project
Awards
Application form
Please complete and return to [email protected]
by 10am on Monday 21st March
1
Section 1 – People
1.1 Principal Applicant
Title
First name
School/Institute
Job title
Is your contract*
Initial
Last name
☐ Permanent
☐ Temporary
If you are a student, please state course
end date*
If temporary,
state end date*
* This will only be used to make sure that your delivery timescales are appropriate
Contact details
Email
Phone number
Address
1.2 Co-applicant(s) (if there is more than one please copy and paste the boxes below)
At least one co-applicant must be a community based organisation, charity or individual.
Title
First name
School/Institute/Organisation
Job title
Is your contract*
☐ Permanent
☐ Temporary
If you are a student, please state course end date*
Initial
Last name
If temporary,
state end date
* This will only be used to make sure that your delivery timescales are appropriate
Contact details
Email
Phone number
2
Section 2 – Aims
Project title
2.1 Please summarise the project. Summaries for successful bids will be used on
the LSI and CPE website and in publicity about the awards (max 200 words)
2.2 Set out up to three aims for this project (max 150 words)
2.3 How are you engaging local communities in East London with this project?
Who are they and how will they be involved? (max 200 words)
2.4 How does this project work towards an identified health and well-being need
in the community? (max 150 words)
3
2.5 How does this activity link to QMUL, the LSI, and its work? (max 150 words)
Section 3 – Methods
3.1 Describe the activity that will take place (max 250 words)
3.2 What are the long-term legacies of this project expected to be (beyond the
initial funding period) (max 150 words)
Project plan
Please set out the timeline of the project, with major milestones and key dates,
finer detail of the project and highlighting any major risks and risk mitigation
steps. Max 2 sides of A4. Please insert this into this form; do not include as a
separate appendix.
4
Completion Date
3.3 How have you considered equality and access (including physical accessibility)
when putting together this proposal? Are there any ethical considerations we
should be aware of, and how do you propose to address them? (Max 150 words)
Section 4 –Evaluation
4.1 What are the indicators of success for this project? These should be linked to
the aims set out in 2.1 (Max 150 words)
4.2 What evidence will you gather to support the above, and how will you do this?
(max 200 words)
5
4.3 How many people do you anticipate you will engage?
6
Section 5 – Finances
Project total (including
match funding)
Match funding secured
Match funding potential
Amount requested
from the LSI
Project Costings
Details and justification
PROJECT TOTAL
Match Funding
Secured funds
Potential funds from
sources (please state if an
application is already in
process)
7
Costs £
Section 6 – Signatures and approval
The principal applicant, co-applicant(s), and Head(s) of Department are required to
sign this form to accompany an application.
Principal Applicant and Co-applicants
I enclose an application for a research project grant/proposal for approval. I am not
aware of any relevant information that has been withheld or of any information
given in the proposal that is misleading.
Name (in block capitals)
Signature
Date
Head(s) of Department/School/Institute*
I confirm that I have read and support this proposal and that I am not aware of any
relevant information that has been withheld or of any information given in the
proposal that is misleading. I agree to this activity being carried out in my
Department/School/Institute.
* An email of support will be sufficient, to [email protected]
Name (in block capitals)
Signature
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Date