KNOWLEDGE EXCHANGE AND ENTERPRISE FUNDING KNOWLEDGE EXCHANGE SECONDMENT APPLICATION To be accompanied by: short (max 4 page) CV for the secondee (academic staff secondees should also include a completed sabbatical leave form) General Call Project title PI/ Academic Lead at UCL UCL Department Partner Organisation KE Secondment Name Name Organisation type Number of employees Lead contact name Email Email Address Secondee Name Email Type Delete as appropriate Outward (to partner) / inward (to UCL) Project Track Record Summary of underpinning research for secondment project Research grant details (awarding body, reference number) Previous KE from project including details of any funding received Previous engagement between UCL and Partner Vice-Provost (Enterprise), University College London 2nd Floor, Gordon House, 29 Gordon Square, London, WC1H 0PP www.ucl.ac.uk/enterprise Planned Activities for period on secondment List the main objectives to be carried out List the key stages of work to be undertaken Describe the expected benefits to the Partner organisation resulting from the activity. Quantify the benefits. Describe the expected benefits to UCL resulting from the activity including the impact on UCL’s research and teaching. Outline the benefits to the secondee resulting from participating in this activity Outline the future plans following successful completion How does this plan fit in with UCL’s enterprise strategy? Vice-Provost (Enterprise), University College London 2nd Floor, Gordon House, 29 Gordon Square, London, WC1H 0PP Tel: +44 (0)20 3108 5071 Fax: +44 (0)20 3108 5072 Email: VPEnterprise@ucl.ac.uk www.ucl.ac.uk/enterprise Financial Proposed Start Proposed End Directly incurred costs requested (£) Staff to be funded Date Date Consumables Travel Name Total Employee number Salary spine point UCL background Delete as appropriate Not applicable/doctoral student/PRDA/technical or support staff/teaching staff FTE of secondment Date from/to Describe overall expected spend profile over time Justification of resources requested Partner(s) Contribution (£) Direct In kind Total e.g. management supervision time, training costs, materials, partner overheads. *Please note these are not fundable Details of Contribution from Partner Organisation Cost Centre first 2 letters of account code Departmental Administrator Name Office use only HoD approval Panel outcome Funding Source Direct Costs Funds awarded Estates and Indirects Funds awarded Account Code Amendments pFACT costing number Salaries with oncosts Vice-Provost (Enterprise), University College London 2nd Floor, Gordon House, 29 Gordon Square, London, WC1H 0PP Tel: +44 (0)20 3108 5071 Fax: +44 (0)20 3108 5072 Email: VPEnterprise@ucl.ac.uk www.ucl.ac.uk/enterprise Email Consumables and Travel Total KNOWLEDGE EXCHANGE SECONDMENT IMPACT CAPTURE TO BE COMPLETED AT PROJECT END General Call KE Secondment Project title PI/ Academic Lead at UCL UCL Department Partner Organisation Name Secondee Name Email Name Lead contact name Address Email Project Track Record Original Project Aims Any changes made to the original aims Detail any impact on the partner organisation’s business. as a result of the secondment i.e securing new business, generating new profit, improving knowledge and skills of partner organisation staff Detail any impact on UCL’s research , teaching and enterprise activity a result on the secondment Detail any impact on the secondee as a result of the secondment List any follow on activity being undertaken Vice-Provost (Enterprise), University College London 2nd Floor, Gordon House, 29 Gordon Square, London, WC1H 0PP Tel: +44 (0)20 3108 5071 Fax: +44 (0)20 3108 5072 Email: VPEnterprise@ucl.ac.uk www.ucl.ac.uk/enterprise