Collaboration for Leadership in Applied Health Research and Care for
Nottinghamshire, Derbyshire and Lincolnshire (CLAHRC-NDL)
Research into Practice (RIPple) placement opportunity for Nurses,
Allied Health Professionals and other non-medical professions
The RIPple programme 2013 - Application form
This application form should be completed after reading the RIPple 2013 invitation letter.
The completed form should be no more than three pages long.
Discussing or submitting your application:
The first step is to register your interest in the programme by contacting John Lewin john.lewin@nottingham.ac.uk
When registering your interest you can also book a slot for an informal discussion of your
proposal on Wednesday 12th December 2012. You can still submit an application even if
you are unavailable on the 12th and can contact Dr Neil Chadborn on 0115 82 32471 or
neil.chadborn@nottingham.ac.uk for an informal conversation concerning your application at
your convenience until the deadline for applications at 17:00 on Friday 21st December 2012.
Completed applications should be submitted to John Lewin - john.lewin@nottingham.ac.uk
no later than 17:00 on 21st December 2012
Your completed application form should be no more than three pages in length. By
returning a completed application form you are confirming that your line manager supports
your application.
Section 1 – your contact information
1.1
1.2
1.3
1.4
1.5
Name
E-Mail
Telephone
Organisation
Profession, Role
and grade
CLAHRC-NDL, Institute of Mental Health, Triumph Road, Nottingham, NG7 2TU
Web: www.clahrc-ndl.nihr.ac.uk
@CLAHRC_NDL
Section 2 – your interest in RIPple
2.1
Outline your interest in applying for RIPple
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2.2
Outline the objectives for your placement
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Section 3 – research and benefits
3.1
Outline the proposal for you placement
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3.2
What are the expected benefits to your patients for this placement?
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CLAHRC-NDL, Institute of Mental Health, Triumph Road, Nottingham, NG7 2TU
Web: www.clahrc-ndl.nihr.ac.uk
@CLAHRC_NDL
3.3
What are the expected benefits to you, your team and your organisation for this
placement?
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3.4
What is your existing knowledge and experience of conducting research?
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Section 4 – confirmation of line manager support and financial details
By completing this section you are confirming that you line manager fully supports this
proposal and the release of your time for 13 days. We will use the details below to confirm
this agreement.
4.1
4.2
4.3
4.4
4.5
Line manager’s name and
job title
Line manager’s E-Mail
Line manager’s telephone
Line manager’s
organisation
Financial information – please detail a breakdown of the cost of providing 13 days of
cover for your post (including any associated on-costs). Please include the £500.00
grant for patient and public involvement if you wish to use it
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CLAHRC-NDL, Institute of Mental Health, Triumph Road, Nottingham, NG7 2TU
Web: www.clahrc-ndl.nihr.ac.uk
@CLAHRC_NDL