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.
HSE Research Awards on Ageing - Application
Page 1
CHECKLIST FOR APPLICANTS
Please ensure you have included all the information required before submitting
your application:
Checklist
Please tick to confirm
You have fully completed ALL sections of the
YES
Application Form
The
Budget
/
Breakdown
of
Proposed YES
Expenses (Appendix 1)
CV Template for the Principal Investigator / YES
Co-Investigators (Appendix 2)
The Infrastructure Agreement Form
YES
(Appendix 3)
The
Project
Management
GANTT
Chart YES
(Appendix 4)
The Collaborator Agreement Form
YES
(Appendix 5)
CV Template for Newly Recruited Personnel YES
(Appendix 6)
Host Institution / Organisation letter of YES
support and stamp of approval
Ethical Approval (IF REQUIRED)
HSE Research Awards on Ageing - Application
YES
N/A
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OVERVIEW OF THE APPLICATION (Boxes 1- 3)
1. Proposed research title
Project title
2. Proposed project dates
Start date
End date
(can start
no earlier
than
January
2018)
(max. 24
months
duration)
Research project budget (Please complete in Euros (€))
(Please note a further breakdown of budget / proposed expenses is required in
Appendix 1)
3.
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
If ‘Yes’, for what amount?
No
€
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)
Position
Will the Principal Investigator hold a post
that covers the duration of the research
award?
Yes
No*
*If No, please see Section Research Team
and Environment of the Guidance Notes
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)
Position
Organisation/Faculty
Address
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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6. Co-Investigator Number 2
Name (including title)
Position
Organisation/Faculty
Address
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)
Position
Organisation/Faculty
Address
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)
Position
Organisation/Faculty
Address
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)
Position
Discipline
Organisation
Address
Email address
10. Collaborator Number 2
Name (including title)
Position
Discipline
Organisation
Address
Email address
11. Collaborator Number 3
Name (including title)
Position
Discipline
Organisation
Address
Email address
12. Collaborator Number 4
Name (including title)
Position
Discipline
Organisation
Address
Email address
13. Collaborator Number 5
Name (including title)
Position
Discipline
Organisation
Address
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 approval
Does 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 application
Have 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 project
Work Package Number
Work Package Tasks
Role of Principal
Time to be dedicated to Total amount of time to
Investigator
this project in total
be dedicated to this
days
project as an overall %
of your time
1
2
3
4
5
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
Work Package
Co-Investigator
Role of CoTime to be
Total amount of
Number
Tasks
Name
Investigator
dedicated to this
time to be
project in total days
dedicated to this
project as an
overall % of your
time
1
2
3
4
5
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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
1
2
3
4
5
Work Package Tasks
Collab-1
Role
Collab-2
Role
Collab-3
Role
Collab-4
Role
Collab-5
Role
Time to be dedicated to this
project in total days
* 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 award
Name, title and position of
authorised signatory
Email address
Signature of authorised
signatory
Date
Official Organisation Stamp
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DECLARATION AND SIGNATURES OF APPLICANTS (Box 34)
34. Declaration and Signatures
In 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
Investigator
Co-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 contacted
Name / 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)
Amount Requested (€)
Description
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 NUMBER
CAREER 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
Title of the award
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 Investigator
As the Principal Investigator I confirm, to the best of my knowledge, that the information provided in this application is correct
Name (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
Work
Objective(s) Task
Deliverable
Package
(s)
Number
1
2
3
4
1
2
3
4
5
Months
6
7
8
9
10
11
12
5
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
Collaborator
Name, 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
Type of Income/Expenditure**
Please provide details and justification for
Support (€)
all items listed
Consumables
Expert
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
EDUCATION
Please include details of post-graduate training relevant to area, awarding body and date
CAREER PROFILE
Employment gained within the last five years relevant to the position
ROLE IN PROJECT
Please include details of key responsibilities and percentage of time to be dedicated to the project
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