OFFICE FOR HEALTH AND MEDICAL RESEARCH
EXPRESSION OF INTEREST (EOI) FORM
GENOMICS COLLABORATIVE GRANTS PROGRAM 2014
DEADLINE 5PM 25th August 2014
SECTION A – ADMINISTRATIVE SUMMARY
A.1
Application Title
Provide a short descriptive title (maximum 200 characters including spaces).
A.2
Administering Institution
Administering Institution Details
Institute Name
A.3
Administering Institution Contact
Select a Title: Choose a Title
Family Name:
Given Name:
Postal Address:
Genomics Collaborative Grants Program 2014
Telephone:
Mobile:
Email:
A.4
Chief Investigator Details
Select a Title: Choose a Title
Family Name:
Given Name:
Postal Address:
Telephone:
Mobile:
Email:
Are you an Australian Citizen/ Permanent Resident?
Are you located in New South Wales?
YES
YES
☐
☐
NO
NO
☐
☐
SECTION B – PROJECT PROPOSAL
B.1
Lay Project Summary
In lay terms summarise the application referring to aims, significance and expected outcomes
suitable for NSW Health website and media releases (maximum 2500 characters including spaces).
Guidelines
2|Page
Genomics Collaborative Grants Program 2014
B.2
Short Form Proposal
Summarise the application referring to aims, significance and expected outcomes. Please include how
the project meets the aims and use the guidelines under each heading (maximum 500 words each):
1.
Objectives, design and expected outputs and outcomes (50%)
This should include an outline of the study design under the following headings: Aims and
Objectives, Background, Research Plan, Analysis, Specific Outputs, Expected Outcomes.
Responses should correspond with the Selection Criteria. It should include a description of
the nature and number of bio-specimen samples to be sequenced, any tests already done,
patient information linkages, subject selection criteria and any other relevant information.
Short Form Proposal (500 Word Cap):
Guidelines
3|Page
Genomics Collaborative Grants Program 2014
2.
Significance of the Expected Outcomes and/or Innovation of the Concept (25%)
Outline the clinical relevance of the project and the likely impact it will have on clinical
practice in NSW, Australia and the world. Proposals should focus on areas of substantial
research need and benefit, where the outcomes are anticipated to be feasible for
adoption into the health system. Briefly outline how the proposal will sit in the ‘bench to
bedside’ continuum for research translation. Provide a brief analysis as to how the
impacts of the project as described will deliver ‘value for money’ in the health system.
Short Form Proposal (500 Word Cap):
Guidelines
4|Page
Genomics Collaborative Grants Program 2014
3.
Team Quality and Capability, relative to opportunity (25%)
The expertise and experience of the research team relevant to the project, their
collaborative potential and potential collaborators and success in obtaining and delivering
past grant funding. An overview of previous achievements of the team and/or of
collaborative effort of team members should be provided.
Short Form Proposal (500 Word Cap):
SECTION C – BIOINFORMATICS AND GENOME SEQUENCES
C.1
Requested Bioinformatics Services and Genome Sequence amounts.
ITEM
DETAILS
NUMBER OF
SEQUENCES
COMMENTS
DETAILS
SERVICE
SOURCE
COMMENTS
Whole Genome
Sequencing at the
Garvan Institute
ITEM
Bioinformatics services
(indicate if sourced from
the Garvan or elsewhere)
Guidelines
5|Page
Genomics Collaborative Grants Program 2014
SECTION D – ETHICS AND CONSENT
D.1
Ethics
Please outline whether ethics approval has been obtained;
If yes – Please include which ethics committees have approved the project, If there are any
conditions attached to the approval, please outline these as well.
If no – Please outline your plan for ethics approval.
D.2
Patient Consent
Please outline whether patient consent has been obtained;
If yes – for what components of the project and in what capacity.
If no – Please outline your plan for gaining patient consent and what it will cover.
SECTION E – PROJECT FUNDING
E.1
Does the project have funding secured?
If yes – list sources
If no – Please outline how will funding be secured for the remainder of the project?
Guidelines
6|Page