Research grant application form
Please email completed form and attachments to info@cclg.org.uk by
the advised deadline for the grant round you are applying for. If you
have not received an acknowledgement within three working days,
please contact 0116 252 5858
Little Princess Trust
Project Grant Application
PART ONE: APPLICATION DETAILS
1. Title of the study:
2. Applicants
Applicant 1
(Lead applicant)
Applicant 2
Applicant 3
Title
Surname
Forename
Post held
Institution
Number of hours per
week expected on project
If there are more than three applicants, please attach an additional page
3. Institution that would be administering the grant
Name
Address at which
work will be
undertaken
4. Proposed timetable
Start date:
Duration (months):
5. Please indicate broad area of grant sought
Basic/fundamental
science
Translational
science
Clinical science
Other
6. Total grant requested
£
7. Summary of requested support (full details to be given in part 3)
Year 1
Year 2
Year 3
Total
Staff
Consumables
Travel & subsistence
Exceptional items
Equipment
Total
8. Does the project require ethical approval for working with human subjects?
If yes, please attach, or indicate when this is likely to be granted. An award will not activate
until ethical approval is confirmed in writing
No
Yes, approved and attached
Yes, approval pending
If pending, date expected:
9. Are animal studies involved?
No
Yes
If yes, please briefly describe the nature of the involvement and the status of any project licence
holder procedure in relation to this application:
10. Other sources of funding
a. Has earlier research relevant to this study by your or your team been externally funded?
No
Yes
If yes, please give details:
Topic
Supporting organisation
Value of grant(s)
Start date and duration of grant(s)
b. Is this application or a related application being submitted elsewhere?
No
Yes
If yes, please give details:
To which organisation?
When is a decision anticipated?
c. Has this application been submitted elsewhere during the last 12 months?
No
Yes
If yes, please give details:
To which organisation?
What was the result of the
application?
11. Exploitation
Is the proposed research likely to lead to any intellectual property which may be commercially
exploited (eg via a patent)?
No
Yes
If yes, please give brief details:
The nature of the intellectual
property
The nature of the mechanism(s)
used to determine whether
registration is required
The name and post of the official
responsible for registering any
intellectual property
12. External reviewers
CCLG is happy for applicants to suggest external peer reviewers, but these should not be
collaborators or researchers with whom you have published in the last five years. If you would like
to suggest appropriate external reviewers, please do so below. CCLG reserves the right to select
our own external reviewers.
Name
Institution
Position held
Email address (if known)
You may also provide the names of researchers you who you would prefer did not see the
proposal. This should not be all the researchers in your field, and you will need to provide a reason
why any particular individual should not be consulted:
13. Lay summary
Please give a brief plain English summary of the proposal, its methods, outcomes and/or
deliverables. Please note this summary may be used to screen your application before deciding to
advance your application or by potential peer reviews to decide if they can review your application.
CCLG also reserves the right to publish this summary in the public domain to demonstrate our
research funding to our supporters. Therefore please do not include any confidential or
commercially sensitive information.
14. Institutional approval
The application should be approved by the Head of Department and by the administrative or
finance officer who will be responsible for administering any grant which may be awarded.
Declaration
I confirm that I have read this application and that if a grant is awarded the work will be
accommodated and administered in our institution. The staff gradings and salaried quoted in the
application are correct and are submitted in accordance with the normal practice of this institution.
Head of Department
Name
Institution
Email
Title
Telephone
Signed
Date
Financial/Administrative Officer
Name
Institution
Email
Title
Telephone
Signed
Date
The electronic version of this application can be submitted giving names and date of
‘signature’ by authorised officers. A printed and signed page should be forwarded ASAP to
CCLG by post. Please indicate clearly to which application it belongs:
For printed, signed version:
Title of study:
Lead investigator name:
Post to:
Research Administrator
Children’s Cancer and Leukaemia Group
University of Leicester
Clinical Sciences Building
Leicester Royal Infirmary
Leicester LE2 7LX
15. Applicant contact details
Applicant 1
Name
Post
Department
Institution
Address
including
postcode
Applicant 2
Name
Post
Department
Institution
Address
including
postcode
Applicant 3
Name
Post
Department
Institution
Address
including
postcode
Title
Tel
Email
Title
Tel
Email
Title
Tel
Email
16. Collaborators
Please give details of collaborators on whom the viability of the project is dependent. Include a
statement (letter/email) of willingness to act as collaborator from each person named below.
Collaborator 1
Name
Post
Department
Institution
Address
including
postcode
Collaborator 2
Name
Post
Department
Institution
Address
including
postcode
Collaborator 3
Name
Post
Department
Institution
Address
including
postcode
Continue on a separate sheet if necessary.
Title
Tel
Email
Title
Tel
Email
Title
Tel
Email
PART TWO: THE PROPOSED RESEARCH STUDY
Give a full description of the proposed study (not more than five pages). This account should use
the following headings:








Title of the study
Academic abstract
Purpose of the research
Background/rationale
Indications of where patient benefit will accrue
Plan of investigation and methods to be employed
Detailed justification for the support requested
Plans for dissemination
This should be attached as a separate document when parts one and three of the
application are submitted.
Please confirm file name attached:
PART THREE: DETAILS OF SUPPORT REQUESTED
You can apply for funding for staff, consumables and equipment. As a charity, we only fund the direct costs of research. We do not fund infrastructure
costs or indirect costs.
1. Staff to be engaged in the project
Staff
Research
staff
Technical
staff
Clinical
staff
Other
staff
Grade
Start point on scale
Increment date
Starting salary
Allowances
Superannuation and
NI
1
2
3
1
2
3
1
2
3
1
2
3
2. Proposed annual cost to project of above posts
% of time
Research
staff
1
2
3
Technical
staff
1
2
3
Clinical
staff
1
2
3
Other
staff
1
2
3
Months on project
Year 1 cost
Year 2 cost
Year 3 cost
Total cost
TOTAL COST RESEARCH STAFF:
TOTAL COST TECHNICAL STAFF:
TOTAL COST CLINICAL STAFF:
TOTAL COST OTHER STAFF
TOTALS CARRIED TO PART 1 SECTION 7
Year 1 staff costs
Year 2 staff costs
Year 3 staff costs
Total staff costs
3. Costs of consumables specific to the project
Item(s)
Year 1 cost
Year 2 cost
Year 3 cost
Total costs
TOTALS CARRIED TO PART 1 SECTION 7
4. Travel and subsistence
Conference attendance expenses can be included for dissemination/presentation of project results but not for general education purposes for the
individual
Destination/reason for journey
Number of
journeys
ESTIMATED TOTALS CARRIED TO PART 1 SECTION 7
Travel
Year 1
Subsistence
Year 2
Other costs
Year 3
Total
Total
5. Exceptional items and one-off expenditure
Item(s)
Year 1 cost
Year 2 cost
Year 3 cost
Total costs
TOTALS CARRIED TO PART 1 SECTION 7
6. Equipment
It is expected that equipment is project-specific and that formal quotes will have been received from suppliers
Equipment
ESTIMATED TOTALS CARRIED TO PART 1 SECTION 7
Expiry date of
quote
Year 1
Expected delivery
date
Year 2
Basic price
Year 3
Duties/fees
VAT
Total
PART FOUR: CURICULUM VITAES
Please provide a professional and publications CV for all applicants. Max 2 pages per individual.
These should be compiled into ONE document and attached as a separate document when
parts one and three of the application are submitted.
Please confirm file name attached:
SECTION FIVE: CHECKLIST
Parts one and three (this form) completed and attached
Part two (proposed research study) completed and attached
Part four (curriculm vitaes) completed and attached
Statement(s) of support from all collaborators named at part one, section 7 attached
Above documentation emailed to info@cclg.org.uk
Signed copy of part one, section 14 (declaration) sent by post