HCRA PhD Research Award
2016 APPLICATION FORM
SECTION ONE: FLAGSHIP PROGRAM ALIGNMENT
1. Which HCRA Flagship Program are you seeking
an award from?
☐ Biomarkers and Targeted Therapies
☐ Implementation Science
SECTION TWO: APPLICANT DETAILS
2. First Name
3. Contact Number
4. Student Email
Surname
SECTION THREE: CURRENT SCHOLARSHIPS
5. Are you currently receiving any other
awards or scholarships?
☐ Yes*
☐ Pending*
☐ No
6. *If yes, provide the following details
for award/scholarship(s):
 Name of award
 Annual monetary value
 Duration of award (commence
& expiry date(s)
SECTION FOUR: CURRENT PROGRAM
7. Faculty & School
8. Commencement
(Month/Year)
9. Enrolment Status
10. Primary Supervisor(s)
11. Project alignment to
Translation Pipeline
(HCRA Research
Framework)
Expected completion
(Month/Year)
☐ Part-time
☐ Full-time
Name:
Email:
☐ All
☐ N/A
☐ T1
☐ T1/T2
☐ T2
☐ T2/T3
☐ T3
12. Provide a statement
on how the research is
translational and how
it fits on the
translational pipeline
as indicated above
(Q11).
HCRA PhD Research Award - 2016 Application Form
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SECTION FIVE: RESEARCH PLAN (max 2 pages for this section)
13. Topic Area
☐ Basic Science
☐ Clinical Medicine & Science
☐ Preventative Medicine
☐ Health Behaviour Research
☐ Public Health
☐ Other:
14. Project Title
15. Background
16. Hypothesis/Aims
17. List the key
objectives/milestones
for the project and
briefly describe
progress to date
against these
objectives
SECTION SIX: LAY SUMMARY
18. Provide a lay summary of your project
that can be used by HCRA for
promotional purposes (e.g. news stories,
web content etc.)
Maximum 200 words
SECTION SEVEN: JUSTIFICATION
19. Provide a brief explanation of how you
feel this award will assist you with the
completion of your project.
Some examples to consider might
include –
 Faster completion
 Dissemination of findings
 Collaborations
Maximum 250 words
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SECTION EIGHT: APPLICATION CHECKLIST
☐ Completed application form
☐ Attach copy of Research Plan (timeline) that was completed as part of the UON confirmation
process
☐ Curriculum Vitae
☐ Certified copies of academic transcripts
☐ Letter of support from primary supervisor
SECTION NINE: DECLARATION
(A) Applicant: By signing this application form I certify that all details given in this application are
complete, correct and true. I understand that the provision of false or misleading information
may result in approved funding being withdrawn and reimbursement to HCRA being required.
Applicant Name:
Signature:
Date:
(B) Research Supervisor Approval: I support the candidate’s application for consideration of a HCRA
PhD Research Award.
Supervisor Name:
Title:
Signature:
Date:
HCRA PhD Research Award - 2016 Application Form
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