This application form must be completed by Principal ... Web viewwtsa medical mycology and fungal immunology wtsa application form version 1.3page 12. wtsa medical mycology and fungal

Wellcome Trust Strategic Award (WTSA) Medical Mycology and Fungal Immunology (MMFI)

WTSA APPLICATION FORMPlease complete this Application Form if you wish to submit a research project proposal for one of the WTSA Funding Streams or wish to apply for a Clinical PhD Fellowship. Details of the individual WTSA funding streams, WTSA objectives and research priorities can be found on the WTSA website (http:// www.abdn.ac.uk/mmfi). Please read the accompanying Guidelines for Applicants when completing the application form (found at www.abdn.ac.uk/mmfi). Completed application forms should be returned by the closing date(s), in pdf format to [email protected].

Q1 WTSA Funding Stream for which project proposal is to be considered :

PhD Project ( for International Research Scholarship)

Cross-disciplinary Project (Postdoctoral Fellowship)

Clinical PhD Fellowship

Q2 PRINCIPAL APPLICANT’S DETAILS AND CURRICULUM VITAE

Please refer to the guidelines for further information

(a) Surname: Forename (s):

Telephone numbers (Day):

Mobile:

Contact address:

Email:

Date of birth:

WTSA MEDICAL MYCOLOGY AND FUNGAL IMMUNOLOGY WTSA APPLICATION FORM Version 1.3 Page 1

mailto:[email protected]

http://www.abdn.ac.uk/mmfi


(b) Title of currentpost:

Current institution and address:

Date of appointment:

(c) Previous posts held (list with most recent first)

Date from Date to Position Department University/institution

(d) Education /training:

Date (mm/yyyy) Degree Subject University/institution

(e) Summary of scientific career to date, including key deliverables (no more than 500 words)

(f) PublicationsPlease list all publications from the last three years and up to ten prior publications. Please list only your original research publications and other scholarly contributions that you consider to be significant. List in chronological order with the most recent first.

Please give a citation in full, including title of paper and all authors

(g) Other Research Support

Please list any research funding received or sought for this or other related research in the same field in the past five years and any key prior funding awards (most recent first). Please provide the name of the awarding body, title of the project, the amount of the award and the start and end dates.


Q3 CO-APPLICANT’S DETAILS AND CURRICULUM VITAE (Duplicate as appropriate)

Please refer to the guidelines for further information



Mobile:

Contact address:

Email:

Date of birth:


Current institution and address:



Date from: Date to: Position Department University/institution




(e) Summary of scientific career to date, including key deliverables (no more than 500 words)

(f) PublicationsPlease list all publications from the last three years and up to ten prior publications. Please list only your original research publications and other scholarly contributions that you consider to be significant. List in chronological order with the most recent first.



Please list any research funding received or sought for this or other related research in the same field in the past five years and any key prior funding awards (most recent first). Please provide the name of the awarding body, title of the project, the amount of the award and the start and end dates.

Q4 COMPLETE FOR CLINICAL PHD FELLOWSHIP ONLY: CANDIDATE’S DETAILS AND CURRICULUM VITAE

To be completed by candidates applying for a Clinical PhD Fellowship only. Note that the candidate’s sponsor/supervisor must complete the Principal Applicant section (Q2). Please refer to the guidelines for further information.



Mobile:

Contact address:

Email:

Date of birth:



Current institution and Address:



Date from: Date to: Position Department University/institution



(e) Please indicate why you wish to undertake a research training fellowship and how this will further your career. Explain why you have chosen this Principal Applicant (Supervisor) and Co-Applicant (where applicable) and laboratory/laboratories for your research. (in no more than 500 words)

(f) PublicationsPlease list all publications including original research publications and other scholarly contributions that you consider to be significant. List in chronological order with the most recent first.




Please list all research funding received or sought in the past five years and all key prior funding awards (most recent first). Please provide the name of the awarding body, title of the project, amount of the award, and the start and end dates.

(h) Clinical Status

Current level of clinical contract, if other, please specify:

Name of Health Authority or Hospital Trust:

Date current contract expires:

Please state your chosen clinical speciality, if known

What, if any, accreditation have you obtained in your chosen speciality

Give your General Medical Council (GMC) number:

Do you hold a National Training Number (NTN)?If yes, state NTN and when it was awarded. If no, when do you intend to apply for a NTN?In which postgraduate deanery is your NTN held, or will be held?

Do you hold a Certificate of Completion of Training (CCT)?If yes, state date awarded.


If no, state the expected date to receive CCT, assuming your fellowship application is successful (mm/yy)?

State what level of honorary clinical contract will be sought during this award? If other, please state;

Please state the clinical duties that are essential for the proposed research and the time required each week to perform these duties:

Please state what clinical duties are essential for the minimum requirements for higher training in your speciality, and how you intend to meet them:

Please state the total time you intend to spend each week on clinical work:

Q5 COLLABORATION

Collaborators, i.e. scientific/medical/academic colleagues, who are associated with the research proposal and named in the body of the application, but are not co-applicants or Sponsor. Duplicate if necessary.

Name of collaborator:

Full address:

Extent and nature of collaboration:Detail the role and contribution of the collaborator, with an indication of the time the collaborator will spend on the project (no more than 200 words).

Please detail any reagents the collaborator will provide and indicate if there are any Intellectual Property issues or restrictions arising from Material Transfer Agreements (no


more than 200 words).

Q6 LAY SUMMARY OF PROPOSED RESEARCH (in no more than 200 words)

Please note that if this proposed research project is selected, the lay summary will be published on the WTSA website, so will be publicly available.

Q7 ALIGNMENT WITH WTSA RESEARCH PRIORITIES (in no more than 500 words)

Please describe how the proposed research project matches the priority research areas and criteria as set out by the WTSA Consortium (see Q7 in the guidelines). Address how the project matches the main research priorities (1) drugs and vaccines, (2) diagnostics and (3) understanding of immunology and pathology. Also discuss the project in terms of its (4) interdisciplinarity (5) basic, clinical or translational nature and (6) strategies for the understanding and prevention of disease.

Q8 LOCATION AND MANAGEMENT OF PROPOSED PROJECT (in no more than 200 words)

Please outline the infrastructure, facilities and support available to ensure the successful performance of the proposed research. Indicate if the proposed project will be conducted at more than one institution and describe the management and collaborative arrangements. Describe how the student/PDRA will move to another institution, when in the project timescale and for how long (e.g. percentage of time at each institution).

Will the proposed research project lead to the award of a joint degree? If yes then please describe the arrangements that are already in place or will be put in place to cover this e.g. Institutional approvals and joint award agreements etc. Give timescale for approvals and agreements that are pending.

Q9 DETAILS OF THE RESEARCH PROJECT

(a) Proposed start date:

(b) Project title:


(c)

Outline of research project (no more than 1500 words). Please use typeface 11 point Arial font. Word counts will be checked and applications returned if the limit is exceeded. Two embedded items (Figures or Tables) are permitted and will not add to the word count. Legends are limited to 40 words.

Please include; (a) The research question and why it is important (b) Aims of the project (c) Brief background to the project (d) research plan with a timetable and milestones (e) brief outline of methods and techniques. A separate section for references, maximum 20 and please include relevant references. The references will not be included in the word count.

Q10 COST OF THE PROPOSAL FOR THE FULL DURATION OF THE PROJECT. Please indicate the funding that will be requested from the WTSA and part-funding from other sources for the proposed research project. Insert an additional table if more than two other sources are contributing to overall project costs. Ensure you indicate in Q16 below, if additional sources of funding will restrict or delay data sharing and raise issues around intellectual property rights and exploitation.

Please refer to the guidelines for additional information on studentship stipend, tuition fees, visa costs, the maximum funds available for materials and consumables, travel etc.

Funds Request from WTSA

Funding Body (1) (Insert name)

Funding Body (2) (Insert name)

Salary requested (inc. employer’s contributions and inflation)

£ £ £

Materials and consumables

Animals

Travel, accommodation and subsistence

Other

Total:

Q11 JUSTIFICATION FOR COST OF THE PROPOSAL


Please justify costs requested from the WTSA using the headings above (in no more than 400 words).

Q12 OPTION TO NAME A POSTDOCTORAL RESEARCHER FOR POSTDOCTORAL RESEARCH FELLOWSHIP ONLY

A PA has the option to name a postdoctoral researcher in this application. The individual may be an outstanding researcher and/or have specific experience and skills required for the proposed research project. Give a brief description of the named researcher’s career and achievements to date. (in no more than 100 words). Please submit a CV for the named researcher with the application (no more than 2 A4 pages).

Q13 HUMAN PARTICIPANTS, BIOLOGICAL SAMPLES AND PERSONAL DATA RELATING TO LIVING OR DEAD PERSONS ( in no more than 400 words)

State whether any of the above will be used in the proposed research. Please describe the ethical, legal and regulatory approvals that have to be obtained, including National Health Service (NHS) approval. Please indicate which institution has agreed to be the Sponsor for the proposed research under the Research Governance Framework for Health and Social Care, published by the Department of Health in England or the corresponding devolved departments in Northern Ireland, Scotland or Wales.

Indicate if this project is linked to a clinical trial funded by another source and describe how the trial is linked to this project. Provide details of the relevant approvals and Sponsorship.

Q14 USE OF ANIMALS ( in no more than 400 words)

Does the proposed research involve the use of animals and /or animal tissue? If yes, please provide details of the animal species, number of animals to be used, the source of the animals and how they will be transported and maintained. Briefly describe the procedure(s) to be carried out and the severity. Provide information on the approval(s) obtained or to be obtained (project and personal licence holders). Provide a justification for the use of animals.


Q15 USE OF GENETICALLY MODIFIED ORGANISMS (in no more than 400 words)

Please provide details of any genetically modified organisms that will be used in the proposed research project. Outline the relevant approvals that have been obtained or will be obtained.

Q16 DATA MANAGEMENT AND DATA SHARING (in no more than 400 words)

Please outline your data management and data sharing strategies. Describe how it will be shared with the wider scientific community e.g. deposition in 3rd party repositories and /or databases and expected timeframe. Indicate any anticipated restrictions or delays on data sharing e.g. third party funding, intellectual property and commercialisation issues, confidentiality, ethical issues etc. Please see the Wellcome Trust Policy on Data Management and data sharing http://www.wellcome.ac.uk/About-us/Policy/Policy-and-position-statements/WTX035043.htm

Q17 PARTICIPATION IN WTSA CONSORTIUM ACTIVITIES

Please indicate how you will promote and assist the WTSA Consortium. Examples include; (1) how will you contribute to the WTSA website (http://www.abdn.ac.uk/mmfi) and other social networking fora, (2) public engagement (3) assist the consortium in recruiting to the three funding streams i.e please indicate where potential/suitable candidates can be identified, in particular Clinical PhD candidates (4) would you be willing to organise a WTSA training event, workshop, seminar or public awareness event?

Q18 FINANCIAL ADMINISTRATION

Please provide the name and contact details of the finance officer to contact if an award is made.

Name:

Full postal address:

Telephone no:

Email address:

If awarded payments should be made to:



http://www.wellcome.ac.uk/About-us/Policy/Policy-and-position-statements/WTX035043.htm

Q19 SIGNATURES OF PRINCIPAL APPLICANT, CO-APPLICANT(S) AND CANDIDATE FOR CLINICAL PHD RESEARCH FELLOWSHIP (WHERE APPLICABLE)

I/We confirm that I/we have read the Guidelines for Applicants and that the finances and information provided is correct has been checked and approved by the appropriate personnel at the institution(s) applying for the funding.

If awarded, I/we confirm that we will abide by the terms and conditions of the award.

Please expand if there are more than two co-applicants

Signatures Date

Principal Applicant:

Co-Applicant (1):

Co-Applicant (2):

Candidate for Clinical PhD Research Fellowship:

Q20 APPROVAL BY THE ADMINISTRATING INSTITUTE AUTHORITIES

I/We confirm that I/we approve the submission of this application to the WTSA in Medical Mycology and Fungal Immunology. If awarded, the research and associated staff/student(s) will be accommodated and administrated in the department/school/institution in accordance with the terms and conditions of the award.

The information provided in this application, including the finances, is correct at the time of this application.

To be completed by the Head of department/School To be completed by the Administrative Authority

Title: Title:

Name: Name:

Contact details:

Contact details:

Tel no: Tel no:

Email: Email:

Signature: Signature:

Date: Date:


Documents

This application form must be completed by Principal ... Web viewwtsa medical mycology and fungal immunology wtsa application form version 1.3page 12. wtsa medical mycology and fungal