Faculty of Medicine, Dentistry and Health Sciences
Research Fellowship Scheme
APPLICATION FOR FUNDING IN 2016
Applicants must have held a NHMRC/ARC or equivalent externally funded fellowship which was active at
the University of Melbourne in 2015, and have been unsuccessful in applying for an external fellowship
for funding commencing in 2016. Please see Section 8 if applying for an exemption from these criteria.
Please submit the completed scanned electronic application form to mdhs-grants@unimelb.edu.au by
5pm Wednesday 25 November 2015.
Applicant Name
Staff ID Number
MDHS School and
Department/Centre/Institute
Current Level of Appointment
including step
FTE (Full Time Equivalent)
End Date of Current
Appointment
Current or Recently Ended
Fellowship Type
Anticipated start date of
MDHS Research Fellowship
1. APPLICATION(S) MADE FOR EXTERNALLY FUNDED FELLOWSHIP
List the externally funded fellowship(s) you have applied for in the past year (or justification as to why an
application has not been made). If the fellowship had an interview stage, please indicate if you were invited for
an interview. Please also attach your panel scores and/or any reviewer feedback provided by the sponsor.
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2. PROJECT TITLE
3. PROJECT DESCRIPTION
Description of research project to be carried out during the MDHS Research Fellowship. Please include aims
and significance, research plan and impact/translation of research. Maximum of one page.
4. PROJECT FUNDING
Provide a justification and details of how the project funding budget will be used. Maximum of ½ page
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5.
STATEMENT OF INTENT FOR FUTURE APPLICATIONS
List the externally funded fellowship(s) and grant(s) you will apply for during the tenure of the MDHS Research
Fellowship. Describe the funding scheme, type of fellowship and the likely timetable for the application.
6. DETAILS OF OTHER RESEARCH SUPPORT
In the table below, list details of NHMRC, ARC and all other past/current/requested research support.
Please include the source/scheme, investigators (including CI/AI positions), amount and duration of funding
available. Applicants who do not provide this information will be deemed ineligible.
Description
(all named
investigators on any
proposal in which
applicant is involved,
source, scheme and
round, proposal title)
Support
Status
(Requested,
Current,
Past)
Proposal
ID
2015
($’000)
2016
($’000)
2017
($’000)
2018
($’000)
2019
($’000)
2020
($’000)
Prof AB Example (CI),
Prof EF Example (PI),
Linkage Projects 2016,
Proposal Title
Current Source of
MDHS Fellow
applicant’s salary
Please provide details on the source of the applicant’s current salary
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7. Curriculum Vitae (maximum 5 pages)
Please provide a brief CV (maximum 5 pages) for the last 5 years (2011 onwards) that includes:
 Details of grants and fellowships awarded (listing CI/AI position)
 Top 5 publications (listing citations, H-index and Web of Science/Scopus journal quartile for each
publication) with a statement as to the significance of the publication
 Where applicable, information on the applicants research team (staff and students) and the salary
source for these personnel
 Awards and invitations
 PhD supervisions and completions
8. Productivity relative to opportunity (maximum ½ page)
Please provide a brief statement regarding productivity relative to opportunity in the context of your
employment situation.
9. REQUEST FOR ELIGIBILITY EXEMPTION DUE TO EXCEPTIONAL CIRCUMSTANCES
If you have not held a NHMRC/ARC or equivalent externally funded fellowship which was active in 2015,
and would like to make a case for exceptional circumstances, please provide a detailed statement here
(maximum of 1 page).
A supporting letter signed by both the Head of Department/Centre/Institute and the Head of School
must also be provided with the application.
10.
APPLICANT SIGNATURE
Name of Applicant: ____________________________
Signed (scanned or electronic signature acceptable): _____________________________________
11.
HEAD OF DEPARTMENT/CENTRE/INSTITUTE SIGNATURE:
Name: ________________________
Signed (scanned or electronic signature acceptable): _____________________________________
12.
HEAD OF SCHOOL SIGNATURE (NOT APPLICABLE TO SINGLE DEPARTMENT SCHOOLS):
Name: ________________________
Signed (scanned or electronic signature acceptable): _____________________________________
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