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2016 PROGRAM GRANT
Application form
GUIDELINES FOR APPLICANTS
Closing date for applications
The closing date for receipt of applications by Cancer Council NSW is 5pm (AEST) Monday 27 April 2015.
Applications received after this time will not be accepted.
Advice for completing applications
Applicants should familiarise themselves with the 2016 Program Grant Information for Applicants; 2016 Program
Grant Policy and Condition of Award; 2016 Program Grant Peer Review Guidelines; and the 2016 Program Grant
Consumer Review Guidelines.
Complete the form provided on the following pages; and delete the instructions prior to completing each field.
Delete this page of instructions.
Adhere to the maximum length for each question.
Adhere to the following format specifications:
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

All documents must be on standard A4 paper
Minimum font size of Arial 10 point
All margins must remain at 1.5cm
Paperwork to be submitted
1 electronic copy of the application including completed:
Part A – Administrative Data
Part B – Research Strategy
Part C – Collaborative Gain
Part D – Research Achievements
Part E – Consumer Information
Part F – Certification and Assessors
Certification
Applications must bear the electronic or scanned signatures of all Chief and Associate investigators, Heads of
Chief Investigators’ Departments or Institutions, and the Head of the Administering Institution (or their delegate).
Submission of applications and all enquiries
Ms Nicci Bartley
Project Officer, Research Strategy Unit
Cancer Council NSW
Phone: (02) 9334 1987
Emailed to research@nswcc.org.au
Additional Information
Available from the Cancer Council NSW website or by contacting Nicci Bartley as indicated above.
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2016 PROGRAM GRANT
Application form: Part A
Administrative Data
PROGRAM TITLE
CHIEF INVESTIGATOR(S) DETAILS
Chief Investigator 1 (Chief Investigator 1 will be considered to be the contact point for the application and will be
understood to be acting for and in concurrence with all Chief Investigators)
Full name and title
Department
Institution
Address
City/Suburb, State, Postcode
Telephone
Email
Current appointment
Academic qualifications
(degree, year, institution)
Percentage of working time to
be devoted to this Program
%
Percentage of working time to
be devoted to all other Projects
%
%
Percentage of working time to
be devoted to all other Projects
%
Anticipated period(s) of
absence (if any) and reason
Chief Investigator 2
Full name and title
Department
Institution
Address
City/Suburb, State, Postcode
Telephone
Email
Current appointment
Academic qualifications
(degree, year, institution)
Percentage of working time to
be devoted to this Program
Anticipated period(s) of
absence (if any) and reason
Chief Investigator 3
Full name and title
Department
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Institution
Address
City/Suburb, State, Postcode
Telephone
Email
Current appointment
Academic qualifications
(degree, year, institution)
Percentage of working time to
be devoted to this Program
%
%
Percentage of working time to
be devoted to all other Projects
Anticipated period(s) of
absence (if any) and reason
Please copy above table block and complete details for any additional Chief Investigators
ASSOCIATE INVESTIGATOR(S) DETAILS
Associate Investigator 1
Full name and title
Department
Institution
Address
City/Suburb, State, Postcode
Telephone
Email
Current appointment
Academic qualifications
(degree, year, institution)
Percentage of working time to
be devoted to this Program
%
Percentage of working time to
be devoted to all other Projects
%
%
Percentage of working time to
be devoted to all other Projects
%
Anticipated period(s) of
absence (if any) and reason
Associate Investigator 2
Full name and title
Department
Institution
Address
City/Suburb, State, Postcode
Telephone
Email
Current appointment
Academic qualifications
(degree, year, institution)
Percentage of working time to
be devoted to this Program
Anticipated period(s) of absence (if any) and reason
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Associate Investigator 3
Full name and title
Department
Institution
Address
City/Suburb, State, Postcode
Telephone
Email
Current appointment
Academic qualifications
(degree, year, institution)
Percentage of working time to
be devoted to this Program
%
Percentage of working time to
be devoted to all other Projects
%
Anticipated period(s) of absence (if any) and reason
Please copy above table block and complete details for any additional Chief Investigators
ADMINISTERING INSTITUTION CONTACT DETAILS
Full name and title
Department
Institution
Address
City/Suburb, State, Postcode
Telephone
Email
INSTITUTION(S) WHERE RESEARCH WILL BE CONDUCTED
Institution
Department
Percentage
of research
effort
Please copy above table block and complete details for any additional participating institutions
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COMMON SCIENTIFIC OUTLINE
The common scientific outline is a classification system organised around seven broad areas of scientific interest in cancer research. It provides a framework to
improve coordination among research organisations, making it possible to compare and contrast the research portfolios of public, non-profit, and governmental
research agencies.
Identify (x) the common scientific outline category(s) relevant to your Program.
1. Biology: Research included in this category looks at the biology of how cancer starts and progresses as well as normal biology relevant to these processes.
1.1 Normal Functioning – Developmental biology (from conception to adulthood) and the biology of ageing; Normal functioning of genes, including their identification and
expression, and the normal function of gene products, such as hormones and growth factors; Normal formation of the extracellular matrix; Normal cell-to-cell interactions;
Normal functioning of apoptopic pathways.
1.2 Cancer Initiation: Alterations in Chromosomes – Abnormal chromosome number; Aberration in chromosomes and genes (e.g., in chronic myelogenous leukemia);
Damage to chromosomes and mutation in genes; Failures in DNA repair; Aberrant gene expression; Epigenetics; Genes and proteins involved in aberrant cell cycles.
1.3 Cancer Initiation: Oncogenes and Tumour Suppressor Genes – Genes and signals involved in growth simulation or expression, including oncogenes (Ras, etc.), and
tumour suppressor genes (p53, etc); Effects of hormones and growth factors and their receptors such as estrogens, androgens, TGF-beta, GM-CSF, etc.
1.4 Cancer Progression and Metastasis – Latency, promotion, and regression; Expansion of malignant cells; Interaction of malignant cells with the immune system or
extracellular matrix; Cell mobility, including detachment, motility, and migration in the circulation; Invasion; Malignant cells in the circulation, including penetration of the
vascular system and extrasavation; Systemic and cellular effects of malignancy; Tumour angiogenesis and growth of metastases; Role of hormone or growth factor
dependence/independence in cancer progression.
1.5 Resources and Infrastructure – Informatics and informatics networks; specimen resources; Epidemiological resources pertaining to biology; Reagents, chemical
standards; Education and training of investigators at all levels (including clinicians), such as participation in training workshops, advanced research technique courses,
and Master’s course attendance (this does not include longer-term research-based training, such as Ph.D or post-doctoral fellowships).
2. Etiology: Research included in this category aims to identify the causes or origins of cancer – genetic, environmental, and lifestyle, and the interactions between these factors.
2.1 Exogenous Factors in the Origin and Cause of Cancer – Lifestyle factors such as smoking, chewing tobacco, alcohol consumption, parity, diet, sunbathing, and exercise;
Environmental and occupational exposures such as radiation, second-hand smoke, radon, asbestos, organic vapors, pesticides, and other chemical or physical agents;
Infectious agents associated with cancer etiology, including viruses (Human Papilloma Virus-HPV, etc.) and bacteria (helicobacter pylori, etc.); Viral oncogenes and viral
regulatory genes associated with cancer causation.
2.2 Endogenous Factors in the Origin and Cause of Cancer – Free radicals such as superoxide and hydroxide radicals; Genes known to be involved or suspected of being
mechanistically involved in familial cancer syndromes, for example BRAC1, Ataxia Telangiectasia, and APC; Genes suspected or known to be involved in ‘sporadic’
cancer events, for example polymorphisms and/or mutations that may affect carcinogen metabolism (e.g., CYP, NAT, glutathione transferase, etc.).
2.3 Interactions of Genes and/or Genetic Polymorphisms with Exogenous and/or Endogenous Factors – Gene-environment interactions; Interactions of genes with lifestyle
factors, environmental, and/or occupational exposures such as variations in carcinogen metabolism associated with genetic polymorphisms; Interactions of genes and
endogenous factors such as DNA repair deficiencies and endogenous DNA damaging agents such as oxygen radicals or exogenous radiation exposure.
2.4 Resources and Infrastructure Related to Etiology – Informatics and informatics networks (e.g., patient databanks); Specimen resources (serum, tissue, etc.); Reagents
and chemical standards; Epidemiological resources pertaining to etiology; Statistical methodology or biostatistical methods; Centres, consortia, and/or networks;
Education and training of investigators at all levels (including clinicians), such as participation in training workshops, advanced research technique courses, and Master’s
course attendance (this does not include longer term research based training, such as PhD or post-doctoral fellowships).
3. Prevention: Research included in this category looks at identifying interventions which reduce cancer risk by reducing exposure to cancer risks and increasing protective factors.
Interventions may target lifestyle or may involve drugs or vaccines.
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3.1 Interventions to Prevent Cancer: Personal Behaviours that Affect Cancer Risk – Research on determinants of personal behaviours, such as diet, physical activity, sun
exposure, and tobacco use, that affect cancer risk; Interventions to change personal behaviours that affect cancer risk.
3.2 Nutritional Science in Cancer Prevention – Quantification of nutrients and micronutrients; Studies on the effect(s) of nutrients or nutritional status on cancer incidence;
Dietary assessment efforts questionnaires and surveys; Development, characterisation, and validation of dietary/nutritional assessment instruments.
3.3 Chemoprevention – Chemopreventive agents and their discovery, mechanism of action, development, testing in model systems, and clinical testing.
3.4 Vaccines – Vaccines for prevention, their discovery, mechanism of action, development, testing in model systems, and clinical testing.
3.5 Complementary and Alternative Prevention Approaches – Discovery, development, and testing of complementary/alternative prevention approaches such as diet, herbs,
supplements, or other interventions that are not widely used in conventional medicines or are being applied in different ways as compared to conventional medical uses.
3.6 Resources and Infrastructure Related to Prevention – Informatics and informatics networks (e.g., patient databanks); Specimen resources (serum, tissue, etc.);
Epidemiological resources pertaining to prevention; Clinical trials infrastructure; Statistical methodology or biostatistical methods; Centres, consortia, and/or networks.
4. Early Detection, Diagnosis, and Prognosis: Research included in this category focuses on identifying and testing cancer markers and imaging methods that are helpful in
detecting and/or diagnosing cancer as well as predicting the outcome or chance or recurrence.
4.1 Technology Development and/or Marker Discovery – Discovery of markers (e.g., proteins, genes), and/or technologies (such as fluorescence, nontechnology, etc.) that
are potential candidates for use in cancer detection, staging, diagnosis, and/or prognosis; Use of proteomics, genomics, expression assays, or other technologies in the
discovery of markers.
4.2 Technology and/or Marker Evaluation with Respect to Fundamental Parameters of Method – Development, refinement, and preliminary evaluation (e.g., animal trials and
Phase 1 clinical trials); Preliminary evaluation with respect to laboratory sensitivity, laboratory specificity, reproducibility, and accuracy; Research into mechanisms
assessing tumour response to therapy at a molecular or cellular level.
4.3 Technology and/or Marker Testing in a Clinical Setting – Evaluation of clinical sensitivity, clinical specificity, and predictive value (Phase II or III clinical trials); Quality
assurance and quality control; Inter- and intra-laboratory reproducibility; Testing of the method with respect to effects on morbidity and/or mortality; Study of screening
methods, including compliance, acceptability to potential screenees, and receiver-operator characteristics; Research into improvements in techniques to assess clinical
response to therapy.
4.4 Resources and Infrastructure Related to Detection, Diagnosis, or Prognosis – Informatics and informatics networks (e.g., patient databanks); Specimen resources
(serum, tissue, images, etc.); Clinical trials infrastructure; Epidemiological resources pertaining to risk assessment, detection, diagnosis, or prognosis; Statistical
methodology or biostatistical methods; Centres, consortia, and/or networks; Education and training of investigators at all levels (including clinicians), such as participation
in training workshops, advanced research technique courses, and Master’s course attendance (this does not include longer term research based training, such as Ph.D.
or post-doctoral fellowships).
5. Treatment: Research included in this category focuses on identifying and testing treatments administered locally (such as radiotherapy and surgery) and systemically (treatments
like chemotherapy which are administered throughout the body) as well as non-traditional (complementary/alternative) treatments (such as supplements, herbs). Research into
prevention of recurrence is also included here.
5.1 Localised Therapies: Discovery and Development – Discovery and development of treatments administered locally that target the organ and/or neighbouring tissue
directly, including but not limited to surgical interventions and radiotherapy; Therapies with a component administered systemically but that act locally (e.g., photodynamic
therapy, radioimmunotherapy and radiosensitizers); Development of methods of drug delivery; Research into the development of localised therapies to prevent
recurrence.
5.2 Localised Therapies: Clinical Applications – Clinical testing and application of treatments administered locally that target the organ and/or neighbouring tissues directly,
including but not limited to surgical interventions and radiotherapy; Clinical testing and application of therapies with a component administered systemically but that act
locally (e.g., photodynamic therapy and radiosensitisers); Phase I, II, or III clinical trials of promising therapies that are administered locally; Side effects, toxicity, and
pharmacodynamics; Clinical testing of localised therapies to prevent recurrence.
5.3 Systemic Therapies: Discovery and Development – Discovery and development of treatments administered systemically such as cytotoxic or hormonal agents, novel
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systemic therapies such as immunologically directed therapies (vaccines, antibodies), gene therapy, angiogenesis inhibitors, apoptosis inhibitors, and differentiating
agents; Defining molecular signatures of cancer cells; Identifying molecular targets for drug discovery (includes mechanistic studies of cellular metabolism, combinatorial
chemical synthesis, drug screening, development of high-throughput assays, and testing in model systems; Investigating the molecular mechanisms of drug resistance
and pre-clinical evaluation of therapies to circumvent resistance; Development of methods of drug delivery; Research into the development of systemic therapies to
prevent recurrence.
5.4 Systemic Therapies: Clinical Applications – Clinical testing and application of treatments administered systemically such as cytotoxic or hormonal agents, novel systemic
therapies such as immunologically directed therapies (vaccines, antibodies), gene therapy, angiogenesis inhibitors, apoptosis inhibitors, and differentiating agents; Phase
I, II or III clinical trials of promising therapies administered systemically; Side effects, toxicity, and pharmacodynamics; Clinical testing of systemic therapies to prevent
recurrence.
5.5 Combinations of Localised and Systemic Therapies – Development and testing of combined approaches to treatment; Clinical application of combined approaches to
treatment such as systemic cytotoxic therapy and radiation therapy; Development and clinical application of combined localised and systemic therapies to prevent
recurrence.
5.6 Complementary and Alternative Treatment Approaches – Discovery, development, and clinical application of complementary/alternative treatment approaches such as
diet, herbs, supplements, natural substances, or other interventions that are not widely used in conventional medicine or are being applied in different ways as compared
to conventional medical uses; Complementary/alternative approaches to the prevention of recurrence (please note that primary prevention using complementary or
alternative approaches should be coded under 3.5).
5.7 Resources and Infrastructure Related to Treatment and the Prevention of Recurrence – Informatics and informatics networks (e.g., clinical trials networks and
databanks); Mathematical and computer simulations; Specimen resources (serum, tissue, etc.); Clinical trial groups; Epidemiological resources pertaining to treatment;
Statistical methodology or biostatistical methods; Drugs and reagents for distribution and drug screening infrastructures; Centres, consortia, and/or networks; Education
and training of investigators at all levels (including clinicians), such as participation in training workshops, advanced research technique courses, and Master’s course
attendance (this does not include longer-term research-based training, such as Ph.D. or post-doctoral fellowships).
6. Cancer Control, Survivorship, and Outcomes Research: Research included in this category includes a broad range of areas: patient care and pain management; tracking cancer
cases in the population; beliefs and attitudes that affect behaviour regarding cancer control; ethics, education and communication approaches for patients and health care
professionals; supportive and end-of-life care; and health care delivery in terms of quality and cost effectiveness.
6.1 Patient Care and Survivorship Issues – Quality of life; Pain management; Psychological impacts of cancer survivorship; Rehabilitation; Reproductive issues; Long-term
morbidity; Symptom management, including nausea, vomiting, lymphedema, neuropathies, etc.; Prevention of treatment-related toxicities and sequelae, including
symptom management, prevention of mucosities, prevention of cardiotoxicities, etc.
6.2 Surveillance – Epidemiology and end results reporting (e.g., SEER); Surveillance of cancer risk factors such as diet, body weight, physical activity, sun exposure, and
tobacco use; Analysis of variations in risk factor exposure by demographic or other factors; Registries that track incidence, morbidity, and/or mortality related to cancer;
Trends in use of interventional strategies; Method development for risk factor surveillance.
6.3 Behaviour – Behavioural medicine research and interventions; Influence of social factors such as community, policy, education, and legislation, on behaviours related to
cancer control; Attitudes and belief systems and their influence on psychological health and on behaviours related to cancer control (e.g., how beliefs can alter attempts
to seek screening, detection, and treatment); Interventions to change attitudes and beliefs that affect behaviour related to cancer control and cancer outcomes; Influences
of attitudes and beliefs on compliance with treatment and prevention protocols; Psychological or educational interventions to promote behaviours that lessen treatmentrelated morbidity and promote psychological adjustment to the diagnosis of cancer and to treatment effects; Burdens of cancer on family members/caregivers and
psychological/behaviour issues.
6.4 Cost Analyses and Health Care Delivery – Analyses of the cost effectiveness of methods used in cancer prevention, detection, diagnosis, prognosis, treatment, and
survivor care/support; Development and testing of health service delivery methods; Interventions to increase the quality of health care delivery; Impact of organisational,
social, and cultural factors on access and quality of care; Studies of providers such as geographical or care-setting variations in outcomes; Effect of reimbursement
and/or insurance on cancer control, outcomes, and survivorship support; Access to care issues; Health services research, including health policy and practice; Analysis of
health service provision, including the interaction of primary and secondary care; cost effectiveness of treatments.
6.5 Education and Communication – Development of communication tools and methods; Education of patients, health care providers, at-risk populations, and the general
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population about cancer; Communication to patients regarding therapeutic options; Educational interventions to promote self-care and symptom management;
Communicating cancer risk to underserved populations, at-risk populations, and the general public; Alternative teaching methods to communication therapeutic options
and risk-reduction behaviour to patients and the general public; Communication of lifestyle models that reduce cancer risk, such as communication of nutritional
interventions; Communicating smoking and tobacco cessation interventions; Special approaches and considerations for underserved and at-risk populations; Education,
information, and prevention/screening/assessment systems for the general public, primary care professionals, or policy makers; Training, predictive cancer models, pain
management, and surveillance systems for primary care professionals, telehealth/telemedicine applications; Communication regarding cancer genetics, managed
oncology care, and communicating with survivors; Barriers to successful health communication.
6.6 End-of-Life Care – End-of-life care issues, including palliative care, psychological interventions with families at end of life, hospice care, and pain management for
terminally ill patients.
6.7 Ethics and Confidentiality in Cancer Research – Informed consent modelling and development; Quality of Institutional Review Boards (IRBs); Protecting patient
confidentiality and privacy; Research ethics.
6.8 Complementary and Alternative Approaches for Supportive Care of Patients and Survivors – Hypnotherapy, relaxation, transcendental meditation, imagery, spiritual
healing, massage, biofeedback, etc., as used for the supportive care of patients and survivors; Discovery, development, and testing of complementary/alternative
approaches such as diet, herbs, supplements, or other interventions that are not widely used in conventional medicine or are being applied in different ways as compared
to conventional medical uses.
6.9 Resources and Infrastructure Related to Cancer Control, Survivorship, and Outcomes Research – Informatics and informatics networks; Clinical trial groups related to
cancer control, survivorship, and outcomes research; Epidemiological resources pertaining to cancer control, survivorship, and outcomes research; Statistical
methodology or biostatistical methods; Surveillance infrastructures; Centres, consortia, and/or networks; Psychological, economic, political and health services research
frameworks and models; Education and training of investigators at all levels (including clinicians), such as participation in training workshops, advanced research
technique courses, and Master’s course attendance (this does not include longer-term research-based training, such as Ph.D. or post-doctoral fellowships).
7. Scientific Model Systems: Research included in this category looks at the development of new animal models, cell cultures and computer simulations and their application to other
studies across the spectrum of cancer research.
7.1 Development and Characterisation of Model Systems – Development and characterisation of model systems, including but not limited to: Computer simulation model
systems and computer software development; In vitro models systems; Cell culture model systems; Organ and tissue model systems; Animal model systems such as
drosophila and c. elegans, zebra fish, mouse, etc.
7.2 Application of Model Systems – Research into new ways of applying model systems, including but not limited to: Computer simulations model systems and computer
software development; In vitro model systems; Cell culture model systems; Organ and tissue model systems; Animal model systems such as drosophila and c. elegans,
zebra fish, mouse, etc.
7.3 Resources and Infrastructure Related to Scientific Model Systems – Models made available for distribution to the scientific community; Centres, consortia, and/or
networks; Education and training of investigators at all levels (including clinicians), such as participation in training workshops, advanced research technique courses, and
Master’s course attendance (this does not include longer-term research-based training, such as Ph.D. or post-doctoral fellowships).
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BURDEN OF DISEASE – LEVEL 2
Identify (x) the cancer specific Level 2 Burden of Disease that best describes the area of research of the application. You can select up to three Level 2 Burden of Disease
types and you must allocate a percentage of time against each. The percentage total must not exceed 100%.
Level 1
Level 2
Cancer and other malignant neoplasms
Bone and connective tissue cancers
Check (x)
Brain cancer
Breast cancer
Childhood cancers (may include some leukaemia/ lymphoma and other cancer types)
Colon
Endocrine cancers
Gastrointestinal cancers
Genitourinary cancers
Gynaecological cancers
Haematological cancers
Health system issues related to cancer
Leukaemia
Lung cancers
Lymphomas
Melanoma
Mental health and psychosocial factors related to cancer
Other non-specific Basic Science cancer research
Other non-specific Clinical Science cancer research
Prostate cancer
Public and population health related cancer issues
Skin cancers (non-melanoma)
Total Per cent
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2016 PROGRAM GRANT
Application form: Part B
Research Strategy
PROGRAM SUMMARY (maximum 1 page)
Summarise the aims, hypotheses, research plan and potential significance of the overall program.
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RESEARCH STRATEGY (maximum 8 pages)
Provide detail on the proposed research program. This section should be organised under the following headings:
Background: Outline the scientific background to the applications, critically evaluate existing knowledge, and
identify the gaps in knowledge that the Program is intended to fill.
Objectives: State the scientific objectives that the Program aims to achieve, the hypotheses that will be tested,
and the significance of the proposed Program to cancer control.
Research design and methods: Address in detail the design and methods to be used for each component of the
proposed Program. Make clear how these components will individually and collectively test the hypotheses and
achieve the aims of the Program. Specify the data that will be collected and how they will be collected, analysed
and interpreted. Describe and justify any new methods to be developed in terms of their advantages relative to
existing methods. Identify potential difficulties and limitations of the proposed procedures, and alternative
approaches that might be used to achieve the aims.
References (in addition to the 8 page maximum for the Research Strategy): A list of all references cited in the
Research Strategy must be provided.
BUDGET
a) Provide a maximum 1 page budget per year of funding requested (maximum 5 pages), itemising the support
requested under the headings below. A 1-2 sentence description and/or justification should be provided for
each budget line item. The maximum budget that can be requested is $450,000 per annum.
Staff: List whatever salary you deem appropriate for grant-supported personnel; you are not restricted to NHMRC’s
pre-defined Personnel Support Package salary levels. Amounts requested for grant-supported personnel must
cover all salary and salary on-costs (e.g., payroll tax, workers compensation, leave loading, compulsory and
contributory superannuation). Provide the proposed level of appointment, the annual fraction of full-time for the
appointment, the annual full-time equivalent salary level, and the amount requested. If a staff member is also an
investigator, identify him/her by name. CVs must be supplied for all staff for whom funding is requested at the level
of Academic Level B or higher.
Equipment: Specify individually all items of equipment that cost more than $5000 and attach a written quotation in
support.
Maintenance and consumable items: Itemise in readily understood terms such as interviews, travel costs,
laboratory animals, reagents, etc.
b) Support from Institutions: Describe existing resources and infrastructure critical to the proposed Program’s
success, with a view to reassuring assessors of the Program’s feasibility. You have an additional maximum of
½ a page to provide this information.
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2016 PROGRAM GRANT
Application form: Part C
Collaborative Gain
COHERENCE OF THE RESEARCH TEAM AND PROGRAM (maximum 1 page)
Describe the extent to which the proposed Program of research activities works towards a common scientific end
or ultimate practical application by, for example, addressing a set of inter-related research questions.
RESOURCE MANAGEMENT (maximum 1 page)
Describe how the integration of teams and the distribution of resources will be managed, including an outline of
previous strategies and new collaborative arrangements. Highly regarded applications will demonstrate that the
Administering Institution already has in place the processes by which grant funds and other resources will be
shared between research teams, such that delays in the development of such agreements do not lead to
unnecessary delays in the conduct of the research. Describe how intellectual exchange will be facilitated between
the teams that contribute to the Program.
MULTIDISCIPLINARY AND MULTI-INSTITUTIONAL COLLABORATION (maximum 1 page)
Describe the extent and quality of proposed multidisciplinary and multi-institutional collaboration and its prospects
for adding value to the research proposed.
CHIEF INVESTIGATOR(S) ROLE IN THE PROPOSED PROGRAM (maximum ½ page per CI)
Outline the role of each Chief Investigator in the proposed Program. Provide justification for why each Chief
Investigator is needed, including the specific expertise and experience that each brings to the Program.
TRAINING, CAREER DEVELOPMENT AND MENTORING (maximum 2 pages)
Describe the track records of the Chief Investigator(s) in the provision of research training, career development and
mentoring; and opportunities for these activities to be undertaken within the proposed Program, including the
training and mentoring strategies that will be adopted.
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2016 PROGRAM GRANT
Application form: Part D
Research Achievement
CURRICULUM VITAE OF CHIEF INVESTIGATOR(S)
Chief Investigator 1
1. Brief (maximum 1 page) biography, including career disruption
2. List of publications/high quality technical reports since January 2010, including those under review.
Highlight publications especially relevant to this application
3. Research support from all sources for all projects completed since January 2010, currently held or pending
funding decisions. Use the following headings and under each, tabulate: funding body, title of grant, chief
investigators, time commitment (%) (current and requested applications only), period of support and total
funding for the grant period
a) Completed since January 2010
b) Support currently held (at time of submission of this application)
c) Requested (for next year excluding this submission. For NHMRC Project Grants, please provide
NHMRC application number).
4. Invitations/prizes/awards
5. Research application
6. Community Engagement
Chief Investigator 2
1. Brief (maximum 1 page) biography, including career disruption.
2. List of publications/high quality technical reports since January 2010, including those under review.
Highlight publications especially relevant to this application.
3. Research support from all sources for all projects completed since January 2010, currently held or pending
funding decisions. Use the following headings and under each, tabulate: funding body, title of grant, chief
investigators, time commitment (%) (current and requested applications only), period of support and total
funding for the grant period.
a) Completed since January 2010
b) Support currently held (at time of submission of this application)
c) Requested (for next year excluding this submission. For NHMRC Project Grants, please provide
NHMRC application number).
4. Invitations/prizes/awards
5. Research application
6. Community Engagement
Chief Investigator 3
1. Brief (maximum 1 page) biography, including career disruption.
2. List of publications/high quality technical reports since January 2010, including those under review.
Highlight publications especially relevant to this application.
3. Research support from all sources for all projects completed since January 2010, currently held or pending
funding decisions. Use the following headings and under each, tabulate: funding body, title of grant, chief
investigators, time commitment (%) (current and requested applications only), period of support and total
funding for the grant period.
a) Completed since January 2010
b) Support currently held (at time of submission of this application)
c) Requested (for next year excluding this submission. For NHMRC Project Grants, please provide
NHMRC application number).
4. Invitations/prizes/awards
5. Research application
6. Community Engagement
Please copy above table block and complete details for any additional Chief Investigators
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2016 PROGRAM GRANT
Application form: Part E
Consumer Information
CANCER COUNCIL NSW RESEARCH OUTCOMES
Identify (x) the ONE of the following four Cancer Council NSW research outcomes to which the proposed Program
will ultimately contribute most strongly:
Decreased cancer incidence
Increased cancer survival rates
Improved treatment effectiveness
Enhanced quality of life for cancer patients and/or their carers and support networks
LAY DESCRIPTION (maximum 1 page)
Describe the research proposal in lay terms, including how the proposed Program contributes to the Cancer
Council NSW research outcome you selected above. This information will assist the Cancer Council NSW
Consumer Review Panel to understand the significance of your work.
CONSUMER REVIEW CRITERIA (maximum 2 pages)
1. Extent of benefit: Explain how the results of your research will have an important positive impact on
human lives, including any of the following aspects: disease causation, prevention, diagnosis; treatment;
physical and/or mental and/or social wellbeing; quality of life, dignity, and survival
2. Pathway for realising the benefit: Provide a clear description of the steps required to reach the stated
end benefits of the research
3. Potential for application of findings: Explain how the research will be applied in the real world (over the
short, medium or long term), the barriers you need to address to be successful, and how you propose to
address them.
4. Equity: Justify the selection of the study sample and explain why you have included and excluded
particular groups who could potentially benefit from the outcomes of this research. If relevant, outline how
the proposal addresses an under-studied or under-served population and/or a population with a high
burden of disease or poorer outcomes.
5. Consumer involvement: Outline how relevant informed consumers (e.g. from consumer or cancer groups
such as Cancer Voices NSW, Breast Cancer Action Group NSW, Consumers Health Forum, cancer
support groups, organisational in-house research consumer panels, etc) have been involved during the
development of the research proposal; and the plan for ongoing consumer involvement in the research.
Explain how this/these consumer(s) are ‘qualified’ to be involved.
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Insert applicant last name
2016 PROGRAM GRANT
Application form: Part F
Certification and Assessors
CERTIFICATION
Certification by Chief Investigator(s)
In signing this page, you certify that all details given in this application are correct; and you agree to conduct the
Program according to Cancer Council NSW’s 2016 Program Grant Policy and Conditions of Award. Electronic or
scanned signatures are acceptable.
Chief
Investigator
Name (please print in block letters)
Signature
1
2
3
Certification by Associate Investigator(s)
In signing this page you certify, as an Associate Investigator on the Program, to participate in this collaboration.
Electronic or scanned signatures are acceptable.
Associate
Investigator
Name (please print in block letters)
Signature
1
2
3
Certification by Head of Department
I certify that the Program is appropriate to my Department; that my Department can accommodate the Program as
proposed; and that I will support the conduct of the Program in my Department.
Name (please print in block letters)
Department
Signature
Electronic or scanned signatures are acceptable.
Date
Certification by Head of Institution (or delegate)
I certify that this request satisfies the requirements of this institution, and that this institution has established
administrative processes for assuring sound scientific practice in accordance with the Australian Code for the
Responsible Conduct of Research.
Name (please print in block letters)
Title/Position
Signature
Electronic or scanned signatures are acceptable.
Date
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Insert applicant last name
This page will be removed prior to forwarding to assessors for review. Please ensure that all
attachments are inserted prior to this page and that the reverse of this page remains blank.
NOMINATION OF ASSESSOR FOR THIS APPLICATION
Nominate at least three assessors who are suitable for peer review of this application.



At least one international assessor
At least one assessor in Australia outside NSW
State any beneficial relationship that exists between the applicant and the nominated assessors
Nominated Assessor 1
Name
Position
Department, Institution
Address
City/Suburb, State, Postcode
Country
Phone
Email
State any beneficial
relationship that exists
between the nominee and the
applicant
Nominated Assessor 2
Name
Position
Department, Institution
Address
City/Suburb, State, Postcode
Country
Phone
Email
State any beneficial
relationship that exists
between the nominee and the
applicant
Nominated Assessor 3
Name
Position
Department, Institution
Address
City/Suburb, State, Postcode
Country
Phone
Email
State any beneficial
relationship that exists
between the nominee and the
applicant
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Please copy above table block and complete details for any additional nominated assessors
Declaration of assessor agreement
I have contacted all of the above nominated assessors; and all have agreed to review this application if selected by
the Cancer Council NSW Program Grant Selection Committee.
Signature
Electronic or scanned signatures are acceptable
Date:
Consent to provide information to International assessors
I consent to Cancer Council NSW sending my personal information overseas, for the purpose of the peer review of
applications.
Signature
Electronic or scanned signatures are acceptable
9 February 2015
Date:
17
Insert applicant last name
INAPPROPRIATE ASSESSOR(S)
Nominate any assessors who are not suitable to peer review this application. Please include reasons e.g. conflict of
interest, close association, etc.
Inappropriate Assessor 1
Name
Position
Department, Institution
Address
City/Suburb, State, Postcode
Country
Phone
Email
Reason
Inappropriate Assessor 2
Name
Position
Department, Institution
Address
City/Suburb, State, Postcode
Country
Phone
Email
Reason
Inappropriate Assessor 3
Name
Position
Department, Institution
Address
City/Suburb, State, Postcode
Country
Phone
Email
Reason
Please copy above table block and complete details for any additional inappropriate assessors
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