Surname:
Proposal Title:
Proposal Acronym:
Keywords:
Forename and Surname of the Applicant:
Name of Host Department:
Date of Submission:
(Further details in the Guide for Applicants)
Project Acronym:
This project has received funding from the
European Union’s Seventh Framework
Programme for research, technological development and demonstration under grant agreement no 609431.

Surname: Project Acronym:
This section should provide a maximum of 1 page summary of Part B, describing in particular:
 the specific goal(s) and ground-breaking nature of the proposed work
 the expected impact of the proposed work

Surname:
Project Acronym:
Describe the objectives, goals and perspectives of the proposed research project.
Describe how your proposed research project compares with, and represents a step beyond, the state of the art. Describe the novelty, originality and ground-breaking nature of the project.
A work plan should be presented as follows: i) ii)
Provide a compact description of the work plan and methods, potentially broken down in WP(s)
Provide a realistic time schedule of the planned work.
Describe the expected impact of the project on research and potentially beyond. In addition, describe impact and benefit to the fellow’s career .

Surname:
Project Acronym:
Describe any ethical issues that may arise in the action, filling the following form below:
Informed Consent

Does the proposal involve children?

Does the proposal involve patients or persons not able to give consent?

Does the proposal involve adult healthy volunteers?

Does the proposal involve Human Genetic Material?

Does the proposal involve Human biological samples?

Does the proposal involve Human data collection?
YES NO PAGE
Research on Human embryo/foetus

Does the proposal involve Human Embryos?

Does the proposal involve Human Foetal Tissue / Cells?

Does the proposal involve Human Embryonic Stem Cells?
Privacy

Does the proposal involve processing of genetic information or personal data (e.g. health, sexual lifestyle, ethnicity, political opinion, religious or philosophical conviction)

Does the proposal involve tracking the location or observation of people?
Research on Animals

Does the proposal involve research on animals?

Are those animals transgenic small laboratory animals?

Are those animals transgenic farm animals?

Are those animals cloned farm animals?

Are those animals non-human primates?
Research Involving Developing Countries

Use of local resources (genetic, animal, plant etc)

Impact on local community
Dual Use

Research having direct military application

Research having the potential for terrorist abuse

Surname: Project Acronym:
ICT Implants

Does the proposal involve clinical trials of ICT implants?
I CONFIRM THAT NONE OF THE ABOVE ISSUES
APPLY TO MY PROPOSAL
Please note that – in accordance to EU and national legislation – an ethical check will take place during the evaluation and an ethical review will take place for proposals dealing with sensitive issues. If applicable, please provide on this page already a short description how any ethical issues will be addressed. Please note, proposals may be rejected on ethical grounds if such issues are not dealt with satisfactorily. (Further information can be found in the Guide for
Applicants).