Wellcome Trust Strategic Award (WTSA)
Medical Mycology and Fungal Immunology (MMFI)
WTSA APPLICATION FORM
Please 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 MMFI-Hub@abdn.ac.uk.
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:
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(b)
Title of current
post:
Current
institution and
address:
Date of appointment:
(c)
Previous posts held (list with most recent first)
Date from
(d)
Date to
Department
University/institution
Education /training:
Date (mm/yyyy)
(e)
Position
Degree
Subject
University/institution
Summary of scientific career to date, including key deliverables (no more than 500 words)
(f)
Publications
Please 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.
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Q3 CO-APPLICANT’S DETAILS AND CURRICULUM VITAE (Duplicate as appropriate)
Please refer to the guidelines for further information
(a)
Surname:
Forename (s):
Telephone
numbers (Day):
Mobile:
Contact
address:
Email:
Date of birth:
(b)
Title of current
post:
Current
institution and
address:
Date of appointment:
(c)
Date from:
(d)
Previous posts held (list with most recent first)
Date to:
Position
Department
University/institution
Education /training:
Date (mm/yyyy)
Degree
Subject
University/institution
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(e)
Summary of scientific career to date, including key deliverables (no more than 500 words)
(f)
Publications
Please 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.
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.
(a)
Surname:
Forename (s):
Telephone
numbers (Day):
Mobile:
Contact
address:
Email:
Date of birth:
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(b)
Title of current
post:
Current
institution and
Address:
Date of appointment:
(c)
Date from:
(d)
Previous posts held (list with most recent first)
Date to:
Department
University/institution
Education /training:
Date (mm/yyyy)
(e)
Position
Degree
Subject
University/institution
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)
Publications
Please 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 give a citation in full, including title of paper and all authors
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(g)
Other Research Support
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
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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).
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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:
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(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
Salary requested (inc.
employer’s contributions
and inflation)
£
Funding Body (1)
(Insert name)
£
Funding Body (2)
(Insert name)
£
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).
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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.
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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 3 rd 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/Aboutus/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:
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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:
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