JV216-BreastCancer
Partnership Programme Request for Proposals
Breast Cancer Research in New Zealand 2016
Module 1 of the application must be completed on the HRC Gateway to register the application and receive an
HRC Ref ID#. This form contains a Coversheet, Modules 2, Module 3 and sections 4A-4D of Module 4. The
contract information (objectives and milestones) is completed via HRC Gateway and the budget file for Module 4
(sections 4E-4G) must be uploaded separately. Module 5 contains Named Investigator CVs that are uploaded
separately. Module 6 is the research classification of the research that must be completed via HRC Gateway.
Module 7 is the administrative agreement and is only required to be included with the original hard copy of the
application.
This form must be downloaded and completed by applicants before being uploaded to the HRC Gateway as a pdf
file. The complete application with all Modules will be generated by the HRC Gateway for downloading and
printing.
Coversheet
HRC Ref ID#:
Click here to enter HRC Ref ID#
NI:
Click here to enter surname.
Computer used to complete this form:
Click here to enter Windows or Mac.
This COVERSHEET is for identification purposes. It will be replaced by the online pages in the final
submitted application compiled by the HRC Gateway (https://gateway.hrc.govt.nz).
Enter the details above before going to page 2.
When completed, save this form as a pdf file before uploading to the HRC Gateway. In the pdf version
of this document, Module 2 must begin on a new page.
Use only Arial 10 point or 11 point type when completing this form.
Double-click the second page header, replace “surname” with the first named investigator’s surname
and add HRC Ref ID. Double-click elsewhere on the form to return to main part of form.
Before completing this application form, applicants are advised to:
1)
2)
3)
4)
Read the Partnership Programme Application Guidelines for the Breast Cancer Research in New
Zealand 2016 RFP for information on completing this form
Read the HRC Rules for applicant eligibility criteria and budgetary entitlements
Confirm the application due date for electronic files and hardcopies
Ensure that the correct version of this application form is used.
Incomplete or late applications will not be accepted.
JV216-BreastCancerApplication form © 2016 Health Research Council of New Zealand. All rights reserved.
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HRC Ref ID: 16/xyz
First NI: surname
MODULE 2. PROPOSED RESEARCH
Section 2A – Summary of Proposed Research
There is a 1 page limit for this section. Use the headings provided.
Rationale for research
Insert text here
Relevance to RFP
Insert text here
Aims
Insert text here
Research design and methods
Insert text here
Main outcome measures
Partnership Programme
Insert text here
JV216-BreastCancer Application form © 2016 Health Research Council of New Zealand. All rights reserved.
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HRC Ref ID: 16/xyz
First NI: surname
Section 2B – Description of Proposed Research
There is a 10 page limit for this section. Please address all of the following points. The assessing
committee will use responses under the headings to form a judgement about the merit of the proposal.
Provide an appropriate balance of information and a convincing case for achievement.
You may delete instructions under each heading before writing
Rationale for research
Include information that you feel is essential for the reader of the application to better appreciate or understand
the rationale for your research application. Why is the issue being approached in the way outlined in this
application?
Delete instructions and start writing
Relevance to RFP
Research design and methods
Include your specific research hypothesis (if relevant), and a detailed design that describes sample recruitment
and characteristics (including number, gender and ethnicity where relevant), study methodology, and proposed
methods of data analysis. Where appropriate, provide an estimate of the likely effect size and the sample size
required to detect this (power analysis). Consultation with specialists such as methodologists, statisticians and
health economists before finalising your research design is recommended. It is important that you consider how
the research design and methods will meet the requirements of the RFP and ensure the delivery of any outputs
as stated in the RFP.
Delete instructions and start writing
Responsiveness to Māori
How might your research contribute to the health needs of Māori? What is the health significance and context of
this research to Māori? Discuss the incidence or prevalence in Māori, or indicate if not known to be significantly
different from the general population. Have you sought advice for the study from a Māori
researcher/representative (if applicable)? Note: The declaration on Responsiveness to Māori, which forms part of
the Administrative Agreement with the host institution, is in Section 7B.
Delete instructions and start writing
Dissemination strategy
Provide full details of your proposed dissemination strategy. As all partnership programme initiatives are
designed to contribute to an evidence base for policy and practice this should include how the research results will
be appropriately disseminated to the following end-users: Policy-makers, professional colleagues, health service
funders and providers, the general public, study participants, iwi and other important groups.
Delete instructions and start writing
Track record of the research team relevant to this proposal
Use this section to discuss your current or previous related research and outline the outputs and outcomes from
that research, to demonstrate the ability to deliver the proposed study outcomes in response to the RFP. If the
research in this application arises directly from research undertaken on previous research contracts, please
provide a statement of the original aims and objectives of those contracts and the degree to which these were
met. If the research did not progress as anticipated, provide explanations.
Delete instructions and start writing
JV216-BreastCancer Application form © 2016 Health Research Council of New Zealand. All rights reserved.
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Partnership Programme
The relevance and contributions of this research application to the aims and objectives of the RFP must be clearly
expressed. For example, what is the significance and contribution of the research to this research field; where
relevant, how could the research impact upon health policy and/or the provision of health services? Rather than
wasting valuable space with large amounts of background information on the general health problem, focus on
how your research will contribute to address the problem and/or develop new knowledge.
Delete instructions and start writing
HRC Ref ID: 16/xyz
First NI: surname
MODULE 3. REFERENCES
There is no limit to the number of reference pages. Asterisks are to be placed before the applicants’
publications. Please provide references in full and state full authorship (for example not Smith et al).
Insert references here
Partnership Programme
JV216-BreastCancer Application form © 2016 Health Research Council of New Zealand. All rights reserved.
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HRC Ref ID: 16/xyz
First NI: surname
MODULE 4. CONTRACT INFORMATION AND BUDGET
Use the HRC Excel Spreadsheet ‘JV216-Budget.xls’ for Sections 4E – 4G.
Ensure any page breaks are logically placed to facilitate review.
For the electronic copy of budget form (Section 4E-4G):
Upload the excel file and pdf file to the HRC online submission system.
For the hardcopy of the budget form (Section 4E-4G):
HRC Gateway will merge the budget form into a final pdf version of the complete application, which
can be downloaded and printed for hardcopy submission.
Partnership Programme
JV216-BreastCancer Application form © 2016 Health Research Council of New Zealand. All rights reserved.
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HRC Ref ID: 16/xyz
First NI: surname
Section 4A – Justification of Expenses
Justification of Research Staff (as listed in budget)
Justify the role of all staff (named and un-named). Unnamed postdoctoral fellows should also be justified
here. Please note that unnamed PhD students will be disallowed. “Staff” may include research assistants,
technicians, medical staff, interviewers, support staff or similar, whose names or position titles are listed
in the budget under “Research Staff” and who have specific FTE involvements. Clearly state if staff will be
promoted during the project, or the annual salary inflation will automatically be capped to 3%.
Insert text here
Justification of Working Expenses and Casual Staff (as listed in budget)
Insert text here
Partnership Programme
JV216-BreastCancer Application form © 2016 Health Research Council of New Zealand. All rights reserved.
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HRC Ref ID: 16/xyz
First NI: surname
Section 4B – Previous/Current contracts
List previous / current contracts awarded within the past 5 years. Final HRC reports may be made
available to Assessing Committees.
Copy and paste additional tables if required.
Funding agency
Title of research
Investigators
Start date and duration
Total value
Nature of support (1 sentence)
If HRC contract (HRC Ref #),
was Final Report filed? If not,
why?
Partnership Programme
Funding agency
Title of research
Investigators
Start date and duration
Total value
Nature of support (1 sentence)
If HRC contract (HRC Ref #),
was Final Report filed? If not,
why?
Funding agency
Title of research
Investigators
Start date and duration
Total value
Nature of support (1 sentence)
If HRC contract (HRC Ref #),
was Final Report filed? If not,
why?
Funding agency
Title of research
Investigators
Start date and duration
Total value
Nature of support (1 sentence)
If HRC contract (HRC Ref #),
was Final Report filed? If not,
why?
JV216-BreastCancer Application form © 2016 Health Research Council of New Zealand. All rights reserved.
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HRC Ref ID: 16/xyz
First NI: surname
Section 4C – Other Support
Other Research Applications Awaiting Decision
List other research applications awaiting decision (including those to the HRC). Applicants must advise
the HRC of the outcome of other research applications through their Research Office. Copy and paste as
required for additional pending applications.
Funding agency
Title of research
Named investigators
Start date and duration
Total value
Date of outcome
Areas of overlap with this
Application, HRC Ref#?
Co-Funding
What other agencies or end-users have been approached or committed to joint or partial funding of
this research?
Insert text here
Financial Interest(s)
Do you or any named investigator have a financial interest related to the research or sponsorship of
the research?
Yes
No
Financial interest?
If yes, outline below and provide details of your conflict management strategy.
Insert text here
JV216-BreastCancer Application form © 2016 Health Research Council of New Zealand. All rights reserved.
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Partnership Programme
Funding Agency
Title of research
Named investigators
Start date and duration
Total value
Date of outcome
Areas of overlap with this
Application, HRC Ref#?
HRC Ref ID: 16/xyz
First NI: surname
Section 4D – Letters of Collaboration/Supporting Documents Index
Please list below all memoranda of understanding or subcontracts, and letters of collaboration which
outline material or actual support and supporting budget documents. Refer to the Guidelines for
instructions about how to attach these documents.
Peer Reviewers and Assessing Committee members will see the list below and documents will only be
made available on request.
Insert text here
List of Collaborators (National and International)
Please list all collaborators associated with this project
Collaborator Name
Organisation
Country
Purpose
Support (NZ$
or in-kind)
Partnership Programme
JV216-BreastCancer Application form © 2016 Health Research Council of New Zealand. All rights reserved.
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