ESRC Impact Acceleration Account
Knowledge exchange funding for the social sciences
Michaelmas term 2015/16 - Application form
INSTRUCTIONS
Please complete all relevant fields and submit with the accompanying documentation via your departmental administrator /
research support officer/ institutional IAA support. The deadline for applications is 5pm Friday 12 February 2016.
Related documents: Call specification and guidance for applicants (Call document A), Additional information for administrators
(Call document B). References [A.x] direct applicants to the appropriate sections of the guidance in Call Document A.
PROJECT INFORMATION [see A.7]
Project Title
Project start date
Project Category [see A.3] Please select
one.
Project end date
Kick-starting Impact Award
Impact Acceleration Award
Outgoing Knowledge Exchange Fellowship*
Incoming Visiting Practitioner Fellowship
*KE Fellowships career stage strand
[see A.3 and A.4] Please select one.
Early Career Researcher
Established Researcher
Is this application connected to
another submitted under this call?
Yes
No
If yes, please provide the details of
the second application.
ACADEMIC LEAD(S) [see A.4] The person or persons who will take overall responsibility for the conduct of the project. At least
one Academic Lead must be from the University of Oxford. At least one Academic Lead must be designated as the Principal
Investigator (PI) and will be additionally responsible for managing the grant and reporting requirements. Academic Leads not
designated as a PI will be considered a Co-I. Early Career Researchers may not serve as PIs. Please attach a separate sheet for
any additional Academic Leads.
Academic Lead 1
Surname
Name
Title
Post/Job title
Department/Faculty
Email address
Oxford
Oxford Brookes
Telephone
Open University
Reading
Other
PI?
Early Career Researcher status: (If applicable i.e. within 4 years of DPhil/PhD completion)
Date PhD/DPhil awarded
Date of thesis submission
Academic Lead 2
Surname
Name
Title
Post/Job title
Department/Faculty
Email address
Oxford
Oxford Brookes
Telephone
Open University
Reading
Other
Early Career Researcher status: (If applicable i.e. within 4 years of DPhil/PhD completion)
Date PhD/DPhil awarded
Date of thesis submission
PI?
Academic Lead 3
Surname
Name
Title
Post/Job title
Department/Faculty
Email address
Oxford
Oxford Brookes
Telephone
Open University
Reading
Other
PI?
Early Career Researcher status: (If applicable i.e. within 4 years of DPhil/PhD completion)
Date PhD/DPhil awarded
Date of thesis submission
OTHER ACADEMIC PARTNERS Please list here any academic partners not listed above. Attach separate sheet for additional
academic partners.
Academic Partner 1
Organisation name
Organisation web address
Name(s) of Contact(s)
Email of Primary Contact
Have you worked with this partner before?
Telephone
Yes
No
Academic Partner 2
Organisation name
Organisation web address
Name(s) of Contact(s)
Email of Primary Contact
Have you worked with this partner before?
Telephone
Yes
No
Academic Partner 3
Organisation name
Organisation web address
Name(s) of Contact(s)
Email of Primary Contact
Have you worked with this partner before?
Telephone
Yes
No
NON-ACADEMIC PARTNERS [see A.2 and A.4] Please list here any partner(s) who do not work for an HEI. All applications
should have at least one Non-Academic Partner. Attach separate sheet for additional Non-Academic Partner organisations.
Non-Academic Partner 1
Organisation name
Organisation web address
Name(s) of Contact(s)
Email of Primary Contact
Have you worked with this partner before?
Telephone
Yes
No
Non-Academic Partner 2
Organisation name
Organisation web address
Name(s) of Contact(s)
Email of Primary Contact
Have you worked with this partner before?
Telephone
Yes
No
Non-Academic Partner 3
Organisation name
Organisation web address
Name(s) of Contact(s)
Email of Primary Contact
Telephone
Have you worked with this partner before?
Yes
No
RELEVANT/RELATED RESEARCH PUBLICATIONS [see A.7] List up to 5 academic publications.
1.
2.
3.
4.
5.
SUMMARY BUDGET INFORMATION [see A.7] Attach a costing output (X5 or pFACT) with detailed breakdown of costs.
Total university project costs
Should match FEC on your costing output
Total amount requested from the IAA:
Should match PRICE on your costing
output
Details of any matched grant funding
sought/received (£ and source):
Departmental/College support:
(direct contributions only e.g. support for
event costs, not including FEC contribution)
Cash contributions from partners: (£
and description of what this covers):
In-kind contributions from partners:
(estimated £ and description of
contributions)
OTHER INFORMATION [see A.7]
Declaration of Interests: If applicable
Does the project require
ethical review?
Yes
No
Approved CUREC number If
applicable
All projects supported by this funding must adhere to the University’s Code of Practice and Procedure for Academic
Integrity in Research, and comply with appropriate legal and regulatory requirements. If any form of licence is
needed (e.g. Home Office, Intellectual Property, Radiation Protection) these must be in place before the project
commences. Please check this box to confirm that you have read and agree to these terms.
Where did you hear about this funding
call?