​Form Template draft
*Standard Application Form*
STANDARD APPLICATION FORM
Section: Introduction
Please note the following information and guidance is provided to applicants submitting an i4i
stage 1 application ONLY.
There are a number of resources available to you throughout the online form to help guide you
when submitting a research application and it is advised that you take care to read
the Guidance for Applicants document as well as the ​online guidance prompts ​(marked as
a ​?​) carefully whilst completing your application.
The deadline for this call is 1pm ​on Wednesday 05 April 2017
Please ensure that all co-applicants invited to collaborate on this application have
confirmed their involvement and approval of the application form content ​well in
advance​ of this deadline.​
Applicants are expected, before submission, to have discussed the content of their application
with their own and any other body whose co-operation will be required in the conduct of the
research.
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Research Details
Research title​
Please provide the title for the project. This should be both concise and clearly descriptive
and should contain keywords relevant to the project.
Host organisation (which will administer any award)​
If your organisation
​
does not appear on this list, please contact the Central Commissioning
Facility​
Please indicate which organisation would act as the contracting organisation if the
application is successful.
NOTE: If your organisation does not appear on this list, please contact the ​Central
Commissioning Facility​.
Research duration​
Please indicate the expected length of the proposed projects in months.
NOTE: i4i Challenge Award projects can be up to a maximum of 60 months in duration.
Proposed start date if awarded funding​
(Cannot be before 01/04/2018)
Please indicate the proposed date on which the project would start.
A 'cannot be before' date has been suggested on your behalf to ensure that there is sufficient
time for pre-contract due diligence, which is carried out by the i4i Secretariat prior to
concluding the contract to confirm IP arrangements and the commercial strategy, to agree the
exact amount of funding and the payment schedule, and to agree reporting requirements and
stage gates for funding.
NOTE: You may not know this date exactly, but a rough estimate must be supplied.
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Section: Lead Applicant Details
Some of the responses required in this section will have been pre-populated based on your
CV details and any remaining fields must be completed.
To update your CV details, please visit the Manage My Details section by selecting 'Save
and Close' at the top of this screen and accessing the left hand menu toolbar.
Title
Forename
Surname
Nationality
Institution
Address
City/Town
Country
Post Code
Phone number
Email
Please ensure that your role on this research and %FTE commitment information is
detailed within the ‘Co-Applicants’ Details’ section.
Provide an approximate breakdown (%) of how your current appointment is divided between
the following activities:
Please use this section to provide an approximate breakdown of how your current
appointment is divided.
%
Service/Clinical
Research
Teaching
Other
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If applicable, please specify what your 'other' activity consists of.
(50 words max)
Administrative Contact Details​
Please provide contact details for any administrative contact, in the host organisation, who
you would wish to nominate as a secondary point of contact for any queries relating to the
research, should it be supported.
NOTE: This person does not need to be a co-applicant
Administrative contact name
Administrative contact job title
Administrative contact telephone number
Administrative contact email address
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Section: Applicant Publication Details
The following CV details are required as part of this research application. They have been
populated from the details you entered in the ‘Manage my Details’ part of this research
management system.
To update your CV details, please visit the Manage My Details area by selecting 'Save and
Close' at the top of this screen and accessing the left hand menu toolbar.
Select and order what you consider to be your ten most relevant publications to date.
●
●
●
●
Add each publication individually.
Use the delete icon to remove a publication from the list.
Click and drag the arrow icon to change the sort order of each publication.
The save button can be used to save the selections in their respective order.
Degrees
(including details of degree subject/professional qualification(s), awarding body and date)
Please ensure that your CV details are up to date.
Present and previous positions held or experience of service user
(​including job title, employing organisation, and start/end dates)
Please ensure that your CV details are up to date.
Selected recent relevant publication(s)
(including list of authors, article title, publication name, volume reference)
Please ensure that your CV details are up to date.
Research awards(s) held
Please ensure that your CV details are up to date.
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*Standard Application Form*
Section: Co-applicant Details
Please note there is a maximum limit of 12 co-applicants.
Please note all co-applicants are expected to make a substantive contribution to the delivery
and management of the project.
Please list the key individuals and organisations who will be participating in the project.
To reflect this, each co-applicant invited ​must​ have confirmed and approved this application
before the submission deadline.
Please note completed CVs for all co-applicants are a mandatory requirement for submission
and will be ‘pulled through’ into the application. To update these details, a co-applicant
should visit the ‘Manage My Details’ section by selecting 'Save and Close' at the top of this
screen and accessing the left hand menu toolbar.
However, co-applicants who are patients, service users or carers are not obliged to complete
a standard CV but are required to provide a summary of any knowledge, skills and
experience relevant to their role in the application. A separate text box is provided for this
purpose in the 'Add applicant role and %FTE commitment...' section.
All key contributors to the project must be represented as co-applicants.
Project teams must have demonstrable experience in all areas relevant to carry out the
project, including scientific, technical, clinical, project management, intellectual property,
commercial and regulatory experience as required. Specialist services or expertise may be
brought into the team through consultancy or sub-contract arrangements, however,
appropriate justification must be provided in the ‘Case for Support’ and ‘Finance’ sections
NOTE: Please note that co-applicants who are patients, service users or carers are not
obliged to complete a standard CV but are required to provide a summary of any knowledge,
skills and experience relevant to their role in the application. A separate text box is provided
for this purpose in the ‘Add applicant role and % FTE commitment...’ section.
Add co-applicant​
POP UP TEXT
Please note if the relevant individual does not immediately appear on this list, ensure that
your search criteria are accurate and refined, using both Forename and Surname fields.
Forename
Surname
The section below, including the finance section, must be completed for each applicant.
Add Applicant role and %FTE commitment…
Please select the name of the applicant from the drop down list below:
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Name of applicant
Please note a colleague should first be ‘invited’, once this has been completed their details
will automatically appear in the field below.
Is this a patient/public co-applicant? ​Yes/No
If yes
Co-applicants who are patients, service users or carers are not obliged to complete a
standard CV but are required to provide a summary of any knowledge, skills and experience
relevant to their role in the application.​
We recognise and value the varied perspectives that patients/service users and carers
bring to a project as applicants. In this section, please provide a summary of any relevant
knowledge, skills and experience that you will draw upon to contribute to this project.
This could include information about:
● Previous or present work (paid or unpaid) with any relevant organisations
● Links with any relevant groups, committees, networks or organisations
● Experience of particular health conditions, treatments, use of services - or as a
member of a particular community
● Knowledge and experience of research including previous research undertaken
● Knowledge and experience of patient and public involvement including previous
involvement activities
● Skills from any other roles that are transferable
● Relevant qualifications, training and learning.
The bullet point list above is not exhaustive. Please include anything else that is relevant to
the application.
(500 words max)
Specify role in research​
Each co-applicant should provide a brief overview of their role in the proposed project.
Further description of their day-to-day contribution to the project can be made within the
'relevant expertise and experience' section in the Case for Support.
(300 words max)
%FTE commitment​
(% value under 100)
Each co-applicant should include the percentage of time that they will devote to the project.
NOTE: Full-Time Equivalent (FTE) =percentage of full-time hours per week.
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Section: Research & Development office contact
Please note we will notify the R&D office of the outcome of this application including any
associated feedback.
Host organisation (which will administer any award)
R&D contact name​
Please provide the name, contact details and job title of the contact person in the R&D
office of the contracting organisation ​so that we are able to notify this person of the outcome
of this application including any associated feedback. In the event of this project being
recommended for funding, we would also need to communicate with this person with regards
to contract negotiations and general management of the project throughout its duration.
NOTE: Please note this person does not need to be included as a co-applicant.
R&D contact job title
R&D contact telephone number
R&D contact email address
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Section: History of this application
Has this application, or a similar application previously been submitted to this or any other
funding body?
Yes
​ No
Select 'Yes' if this application, or part of this application, has been submitted to another
funding organisation or other National Institute for Health Research or Department of Health
funding scheme previously. Previous applications to the i4i programme whether funded or
rejected should also be detailed here.
Title of previous application
Provide the full research title for the application.
(100 words max)
Name of Lead Applicant
Funding body to whom it was submitted​
Identify the organisation to which it was submitted previously.
Funding scheme under which the application was submitted​
Identify the funding scheme to which it was submitted previously.
Please indicate whether this was a Stage 1 (outline) or Stage 2 (full) application.
(Select)
Reference number of previous application​
Provide the reference number for the application.
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Outcome
Funded
Pending
Unsuccessful
Please state the outcome date, if a decision is still pending.
calendar view (dd/mm/yyyy)
If unsuccessful, please indicate why​.
(200 words max)
Where a previous, related application was made, please indicate how this research proposal
differs from the previous application.​
You should highlight both successful and unsuccessful applications that were submitted
to any funding organisation.
For unsuccessful applications, please summarise any changes made to the research in
response to any feedback received.
NOTE: Where there has been a previously successful i4i application, please describe how
this project follows on from the funding received.
(200 words max)
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*Standard Application Form*
Section: Patient & Public Involvement
In this section it is important that you describe, in as much detail as possible, how patients and
the public have been involved in the development of the application as well as plans for
involvement in the proposed research.
​ he NIHR expects the active involvement of patients and the public in the research it
T
supports. NIHR recognises that the nature and extent of active patient and public
involvement (PPI) is likely to vary depending on the context of each study or award.
The Guidance for Applicants​ document provides more information on PPI in research.
In addition: a definition of patient and public involvement in research, further information and
resources are available from ​INVOLVE​; the NIHR ​Research Design Service​ provides
advice on applications and the ​James Lind Alliance​ has a step-by-step guidebook on
involvement in research identification and priority setting.
Were patients and the public actively involved in identifying the research topic/prioritising the
research questions and/or preparing this application?
Yes
​ No
If ' Yes' box is ticked the following text appears:
If yes, please tick all relevant boxes below.
Involved in identifying the research topic/prioritising the research
questions
Involved in preparing the application
Please further describe how patient and public involvement has informed and/or influenced
the development of the application and how patients and the public have been actively
involved.
If you have selected either of the boxes above please further describe the aims of the
involvement and the ways in which you have involved patients and the public.
Explain how patient and public involvement has informed and/or influenced the development
of the research application including any of the following:
●
●
●
●
Identification and/or prioritisation of the research topic
Identification and/or prioritisation of the research questions
Development of the research design
Preparation of the application
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(300 words max)
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If 'No' box is ticked the following text appears:
If patients and the public were not actively involved please explain why patient and public
involvement was not thought necessary.
(150 words max)
Please indicate the ways in which the public will be actively involved in the proposed research,
by ticking all relevant boxes below:
​Design of the research
Management of the research (e.g. steering/advisory group)
Developing participant information resources
Undertaking/analysing the research (e.g. member of the research team)
Contributing to the reporting of the study report
Dissemination of research findings
No plans for involvement
Other​
If ‘Other’ box is ticked the following text appears:
Please explain how patients and the public have been actively involved in other ways.
(100 words max)
If any of the above box(es) are ticked the following text appears (N/A if box ticked 'no plans for
involvement') :
Please give more details, including how patient and public involvement will benefit the
research, the reasons for taking this approach and arrangements for training and support.
​For
the boxes ticked above, please outline:
● the aims of the patient and public involvement
● the ways in which patients and the public will be involved (where appropriate, provide
names of individuals and/or groups (with consent)) and
● a description of any plans for training and/or support
Please note that a budget line for the costs of patient and public involvement is included in
the finance section which applicants are expected to complete.
For further information you can access an ​involvement cost calculator​ and budgeting guide
via INVOLVE’s website.
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(350 words max)
if ticked 'no plans for involvement' box the following text appears :
If there are no plans for active involvement please explain why it is not necessary.
(150 words max)
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*Standard Application Form*
Section: Case for Support – Part 1
Research Title​
This is the full research title of your application as detailed within the initial 'Research
Details' section.
NOTE: This is based on your previous entry within the 'Research Details' section. If you
wish to amend it, you must go back to this section.
Aims and Objectives​
This section should be used to indicate the main aims/objectives of the proposed project.
This section should be used to indicate the main aims/objectives of the proposed project.
Projects in this programme will vary considerably in their design; however, it is expected
that applicants will clearly describe:
● The technology to be developed
● Key aims for the project
● Main hurdles to be overcome technically, clinically and commercially
● Key measures of success
● How the funding will be utilised to achieve the goals set out.
NOTE: The inclusion of a diagrams, pictures or figures to aid description of the technology
being developed is strongly encouraged as part of the ‘Supporting Documentation’
section. Please ensure that any supporting diagrams, pictures or figures are clearly
described.
(450 words max)
Plain English summary
Please summarise your proposed research in plain English.
The importance of a plain English summary
A plain English summary is a clear explanation of your research.
Many reviewers use this summary to inform their review of your funding application. They
include clinicians and researchers who do not have specialist knowledge of your field as
well as members of the public. If your application for funding is successful, the summary will
be used on National Institute for Health Research (NIHR) and other websites.
A good quality plain English summary providing an easy to read overview of your whole
study will help:
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●
●
●
those carrying out the review (reviewers and board and panel members) to have a
better understanding of your research proposal
inform others about your research such as members of the public, health
professionals, policy makers and the media
the research funders to publicise the research that they fund.
If we feel that your plain English summary is not clear and of a good quality then you
may be required to amend your summary prior to final funding approval​.
It is helpful to involve patients / carers / members of the public in developing a plain English
summary.
Content
When writing your summary consider including the following information where appropriate:
● aim(s) of the research
● background to the research
● design and methods used
● patient and public involvement
● dissemination.
The plain English summary is not the same as a scientific abstract - please do not cut and
paste this or other sections of your application form to create the plain English summary.
Further guidance on writing in plain English is available online at NIHR Make it clear
www.involve.nihr.ac.uk/makeitclear ​.
For further support and advice on writing a plain English summary, please contact
your local Research Design Service​ (where applicable). http://www.rds.nihr.ac.uk
(300 words max)
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Scientific abstract of research
Please provide an overview of the project plan.
Please provide a structured summary which outlines the plan of investigation including
deliverables and milestones.
(600 words max)
Background and Rationale
What is/the problem being addressed?
Please provide an indication of the clinical need for the proposed device/technology,
both domestically and globally, outlining the size and nature of the problem(s) to
be addressed.
Evidence for both the clinical and technical rationale should be provided. Reference should
be made to any relevant outputs from research undertaken by the research team or
members there of and other key outputs from others within the field.
The i4i Challenge Awards seek to identify those technologies with the greatest clinical
benefit, along with developing an understanding of how they might be integrated into clinical
decision and treatment pathways, as well as their large-scale implementation. The purpose
of the funding will be to demonstrate usefulness in the clinic and broader applicability.
It is expected that a clear case is made for how clinical practice will be influenced by the
introduction of the proposed device or technology into clinical or health care practice, as
well as the benefits to patients. This should include an explanation for how the proposed
technology will improve on or overcome issues related to the current standard methods,
alongside providing assurances for how it will offer good value.
When indicating the shortcomings of the current clinical practices, techniques and/or
technologies, please explain how the proposed development may present a suitable
alternative to the current state of the art.
(500 words max)
Why is this research important in terms of improving the health of the public and/or patients
and the NHS
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Please describe how the proposed solution may have an impact on patient benefit and
long-term outcome comparing it with the existing standard of care.
(500 words max)
Section: Case for Support – Part 2
Relevant expertise and experience​
Please outline the individual role of each member of the research team, highlighting the skills
and experience of the team that make them well placed to carry out the work.
Outline the individual role of each member of the research team. In addition, please
explain why the group as a whole is well qualified to undertake this research.
If there are any skills missing from the collaboration, please explain how these will be
addressed.
With the ultimate aim for the i4i Challenge Awards being the adoption of new technologies
within the NHS Trust, project teams must encompass all relevant expertise required for
clinical implementation, including (where appropriate) nurses, pathologists, allied health
professionals and commissioners. It is also anticipated that the leading NHS organisation will
work closely with an organisation developing and commercialising the technology being
utilised in the project.
NOTE: If the salary costs of members of the team are not being sought via this application,
there is the opportunity to explain further how their contribution will be supported within the
'Finances' section.
(400 words max)
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Section: Management & Governance
Research management arrangements​
Please explain the practical arrangements for managing the research and its constituent
components.
Please outline the process that will be put in place to ensure that the research is well
managed, commenting on:
• The project management structure that will ensure that milestones are achieved in a
timely manner
• IP management
• Financial management.
Please explain the practical arrangements for managing the project and its constituent
components. Please also highlight the role of any Advisory Groups associated with the
research.​
(​400 words max)
Has any work relevant to this application already commenced?
Yes
​ No
If yes, please give details of any relevant work that has already commenced in the preparation
of this research.
​(200 words max)
Success criteria and barriers to proposed work
Please set out the measurements of success you intend to use and also the key risks to
delivering this research and what contingencies you will put in place to deal with them.
. Please describe how you intend to measure success, what the key risks to your projects
are and what steps you will take to mitigate these risks. Please ensure that these risks are
considered when defining milestones and/or go/no go points for your project.
(400 words max)
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*Standard Application Form*
Section: Intellectual Property & Innovation
The definition of Intellectual Property (IP) includes copyright (such as new software, checklists, scales,
protocols, questionnaires, toolkits, guidelines or similar) and research tools (such as data analysis techniques,
assays, cell lines, biomarkers, materials or equipment and devices) patents, trademarks and designs.
What relevant IP (patents, design right, copyright etc.) is held by the applicants and
how does it relate to this application?​
IP may include:
• Patents
• Trademarks
• Designs
• Copyright (e.g. software, checklists, protocols, questionnaires, etc)
• Research tools (e.g. techniques, devices, assays, cell lines, biomarkers, etc)
• Trade secret
NOTE: Please note that we would not expect an application to elaborate on trade secret.
(300 words max)
Has a freedom to operate search been conducted and by whom?
Yes
​ No
If yes, please provide details of all relevant IP and how it relates to the application.
All related IP ​not​ owned by any of the applicants should be listed, including details
relating to third party licence requirements.
Please indicate briefly the procedure you used to search for existing IP.
NOTE: You should indicate here what you have found from your searches, even if you have
found nothing.
(150 words max)
If no search has been conducted please set out the rationale.
(150 words max)
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Will any IP be produced or improved during the proposed research?
Yes
​ No
If yes, please describe what IP will be produced and/or improved.​
Indicate where and when new or improved IP will arise. Link this back to any existing IP
that you may have previously mentioned above. Indicate why you think the new IP is novel
over what is already known in the literature.
(300 words max)
Please describe how any new IP generated through the proposed research will be recognised,
captured, managed and utilised either through dissemination and adoption in the healthcare
service or through commercial exploitation. Please give details on who will lead on
dissemination and/or ​exploitation.​
Please describe the proposed route to market and by whom, or how you plan on
developing this.
NOTE: The i4i programme supports projects which aim to develop commercially viable
products and devices for use in clinical health care environments.
(300 words max)
What are the key current and future barriers to utilising any new IP/innovation through
dissemination and adoption in the healthcare service or through commercial exploitation e.g.
potential regulatory hurdles?​
Please indicate where and when any regulatory hurdles will arise, referring back to the
research plan.
You should provide an indication of timing and any delays that may occur and whether this is
something you or a commercial partner will have to deal with.
NOTE: You should also indicate whether you are aiming for UK/EU or US approval routes
and state why.
(600 words max)
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Section: Involvement with NIHR Infrastructure
Involvement with other partners
What, if any, other NIHR organisation(s) will partner this research?
▢ Biomedical Research Centre (BRC)
▢ Biomedical Research Unit (BRU)
▢ Clinical Research Facility (CRF)
▢ Collaboration & Leadership Health Research Centre
▢ Other (please specify)
▢ n/a
Please specify what other NIHR organisation(s) will partner this research.​
​Please
provide details of the other organisations involved (including international
collaborations) and, if applicable, explain how any shared funding arrangements would
work.
Describe the role, if any, these will have in the research
(80 words max)
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Section: Other sources of funding
Will this application be supported by any other funding body?
Yes
​ No
Please provide details of the other organisations involved (including international
collaborations) and provide a possible shared funding arrangement.
Please specify the supporting organisation.
Please detail any proposed arrangements for shared funding.​
Please provide details of the other organisations involved (including international
collaborations) and explain how a shared funding arrangement would work.
(150 words max)
Which funding body?
Reference number
The funding amount
The start and end dates of funding
Start date
calendar view (dd/mm/yyyy)
End date
calendar view (dd/mm/yyyy)
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Section: Finances
Total Research Costs Requested​
Please enter the FULL numeric value in £s only.
NOTE: You should avoid the use of shorthand, inclusion of commas or decimal places.
Please explain how the research costs requested have been calculated and justify how they
have been allocated.
Please provide a breakdown of research costs, in as much detail as possible, associated
with undertaking the research and provide justification for the resources requested.
In this section you should provide a brief explanation as to why the following costs are
necessary for the research and why these are attributable to research in accordance with
AcoRD
https://www.gov.uk/government/publications/guidance-on-attributing-the-costs-of-health-and-social-care-re
search​
- staff costs,
- travel, subsistence and conference fees
- equipment (including lease versus purchase costs)
- consumables,
- patient and public involvement
- any other direct costs.
(750 words max)
Please explain how the research provides value for money.
You should describe how this research provides value for money taking into account the
total cost of the research, including the NHS costs.
(500 words max)
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Section: DH Monitoring information
Please use the drop-down menus and tick boxes to provide the information requested. This
will be used by the Department of Health and the NIHR for accountability, audit and monitoring
purposes.
For guidance please see the UKCRC Health Research Analysis which can be found
at ​http://www.ukcrc.org/​.
UKCRC Health Categories
NOTE: For guidance please see the UKCRC Health Research Analysis which can be
found at http://www.ukcrc.org/
Please select all classifications from the below list that are applicable. Click the headings to
expand categories.
Refresh Selected Classifications Summary
UKCRC Health Categories:
Blood
Cancer
Cardiovascular
Congenital Disorders
Ear
Eye
Infection
Inflammatory and Immune System
Injuries and Accidents
Mental Health
Metabolic and Endocrine
Musculoskeletal
Neurological
Oral and Gastrointestinal
Renal and Urogenital
Reproductive Health and Childbirth
Respiratory
Skin
Stroke
Generic Health Relevance
Other
▢
▢
▢
▢
▢
▢
▢
▢
▢
▢
▢
▢
▢
▢
▢
▢
▢
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Section: Research Design Service (RDS) Involvement
Did you contact the RDS?​
Yes
​ No
The NIHR ​Research Design Services (RDS) support those developing application
submissions.
If you have received advice from your local RDS, we would value your feedback on the
services you received in order to improve service.
Your individual comments will not be attributed to you.
NOTE: Responses to these questions will ​not​ constitute a part of the assessment of your
application by the NIHR.
If not, was this because (please tick all that apply)
▢ You felt your team already has sufficient methodological expertise?
▢ You were unaware of RDS support available?
▢ Other
▢ N/A
Please specify.
(50 words max)
Please indicate in which region
How satisfied overall were you with the input of the RDS
To what extent do you feel the quality of your application improved as a result of RDS
involvement?
Would you recommend the RDS to other people developing research proposals?
Reference:​ i4i Challenge Awards Mental Health – Stage 1​
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​Form Template draft
*Standard Application Form*
Please expand on your responses above, explaining the reasons for your choices, and
including details about the extent and nature of the support provided by the RDS. Please
also add any other comments about your experience of using the RDS.
(150 words max)
Reference:​ i4i Challenge Awards Mental Health – Stage 1​
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​Form Template draft
*Standard Application Form*
Section: Suggested Reviewers
Please suggest three potential peer reviewers who have the relevant expertise to provide appropriate peer review
for your application.
These reviewers should be independent and have no conflict of interest with respect to your application and your
suggestions will be used as only one source of peer reviewers and may not be approached to undertake this review.
Add Referee
Title
Forename
Surname
Department
Institution
Telephone
(Inc. Country Code)
Email
Reference:​ i4i Challenge Awards Mental Health – Stage 1​
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​Form Template draft
*Standard Application Form*
Section: Reviewers NOT to approach
Please list up to three individuals who would not be suitable to review this application due to
competing/conflicting interests.
Title
Forename
Surname
Department
Institution
Email
Reference:​ i4i Challenge Awards Mental Health – Stage 1​
​Page 29​ of 32
Date received:
​Form Template draft
*Standard Application Form*
Section: Supporting Documentation
Please include any supporting diagrams, pictures or figures on a single page in a single file.
The total file size should not exceed 5Mb. Files larger than this may not be considered as part
of this submission.
Please note that documentation uploaded in this section may not be incorporated into the
main body of the PDF of the application form; however please be assured that the information
will have been captured by our system as part of the appendix list.
Any other form of supplementary information submitted will not be considered as part
of your application.
Upload a new attachment
Reference:​ i4i Challenge Awards Mental Health – Stage 1​
​Page 30​ of 32
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​Form Template draft
*Standard Application Form*
Section: Declaration
Please declare any conflicts or potential conflicts of interest that you or your co-applicants may
have in undertaking this research, including any relevant personal, non-personal and
commercial interest that could be perceived as a conflict of interest.​
Please declare any conflicts or potential conflicts of interest that you or your co-applicants
may have, including any facts that, should they come to light at a future date, could lead to a
perception of bias. Include any relevant personal, non-personal & commercial interest that
could be perceived as a conflict of interest. Examples include (this list is not all
encompassing), secondary employment, consultancy, financial or commercial gain
(pensions, shareholdings, directorships, voting rights), honoraria, etc. In a case of
commercial sector involvement with the application or the study, please state clearly the
relationship to ownership of data, access to data, and membership of project oversight
groups.
(300 words max)
How did you hear about this call?
(Select)
If other:
Please specify how you heard about this call.
(100 Characters)
Declaration
I confirm that I have read the ​NIHR Carbon Reduction Guidelines and, where possible, taken
steps to reduce the carbon emissions generated by this research.
Please tick this box to confirm that you have read the ​NIHR Carbon Reduction
Guidelines​ ​and, where possible, taken steps to reduce the carbon emissions generated by
this research.
NOTE: Researchers applying for NIHR funding are asked to consider the carbon footprint of
their research and take steps to reduce carbon emissions where appropriate.
Advice on how to do this can be obtained from the ​NIHR Carbon Reduction Guidelines​ ​.
Reference:​ i4i Challenge Awards Mental Health – Stage 1​
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​Form Template draft
*Standard Application Form*
Section: Validation Summary
Top of (online) page
Please follow the next steps in order to complete your application submission process;
●
●
●
Validate all mandatory/required fields listed below (that are required to be
completed/amended before submitting)
Click '​Save and Close​'
Click the '​Submit​' option (this must be completed by ​1pm, 5 April December 2017​)
You will receive an automated email containing an acknowledgment that we have received
your application.
Bottom of (online) page
If there are no validation requirements above you may be ready to submit the application. To
do so '​Save and Close​' the application.
Please note that your submission will not be considered complete until ​all ​applicants have
both confirmed and approved the application and the submit button becomes visible and is
used.
Reference:​ i4i Challenge Awards Mental Health – Stage 1​
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