V1.0 22/09/14 Warwick ESRC Impact Acceleration Account Application Form Applicant Details PI Name PI Status: Please confirm that you have an employment contract for the duration of the proposed activity. Department Email Phone Mobile Co-Investigators and Departments: External, Academic Partners: External, Non-academic Partners: Organisation and Contact name/details (this is mandatory for all applications) Project Details Project Title Start Date End Date Please specify which IAA pathway you would like this to be considered for. Indicate the activity type that best describes your project (as laid out in the guidelines) Amount of funding sought from the Social Sciences Impact Account Describe how you proposed activity and how it will result in impact (3-4 sentences, plain English Summary) RAPID RESPONSE ONLY: Please explain why the application is urgent and therefore requires an expedited review process. Click here to enter a date. Click here to enter a date. ☐Standard pathway [up to £20,000] ☐Rapid-Response pathway [up to £3,000] ☐Responsive ☐Exchanges ☐Translation ☐Knowledge Mobilisation V1.0 22/09/14 Case for Support 1. What is your underpinning research? (200 words) NB the IAA funds the conversion of established research into impact through support for new engagement activities. IAA does not fund basic research development and expects that in most cases research will be well established at the time of application (except in the case of exchanges, secondments and rapid response requests). 2. Describe your Proposed Activity (300 words) 3. What is Your Anticipated Impact? (i.e. the change you expect to occur as a result of your activity) (300 words) V1.0 22/09/14 4. How will you measure and evidence your impact? (200 words) 5. Where proposed activities link to existing funded research and projects, describe the ‘added value’ that this activity will deliver and explain why the activity cannot be funded from the project grant. (100 words) 6. Project Management and Justification of Costs (200 words) - Describe the roles played by the applicant, co-applicants and any external partners. - Provide justification of your expected costs. Financial Summary: Costs should not be FEC Please break down costs by Project Year (nb. IAA award ends 31st March 2018, all expenditure must be incurred by that date). The maximum awards allowed in each of the categories are: Responsive pathway: Up to £20,000 Rapid -response pathway - Up to £3,000 Project Year Year 1 Year 2 Year 3 Year 4 Total Amount of funding requested from the Social Sciences Impact Account Expenditure Details Staffing Travel and Subsistence Equipment Other (please specify) V1.0 22/09/14 Total External Partner’s funding contribution Other University contribution Total project costs External partner (non-academic): statement of support and involvement [A letter of support can be attached to the application as well as, or in place of the external partner statement of support] Head of Department statement of support Please submit the completed form, together with the relevant supporting statements and documents to ESRCImpactAccount@warwick.ac.uk