SOCIETY AWARDS PRELIM 02/12 SOCIETY AWARDS PRELIMINARY APPLICATION FORM The Society Awards are part of the Wellcome Trust’s Engaging Science grants programme which funds projects that investigate biomedical science and its social contexts. Society Awards aim to support public engagement activities that have a significant impact at national or regional level and that address a key need. Society Awards projects should cover at least one of the following areas: examine the social, cultural, historical and ethical impact of biomedical science encourage new ways of thinking about biomedical science encourage high quality interdisciplinary practice and collaborative partnerships investigate and test new methods of engagement, participation and education They should also aim to: stimulate interest, excitement and debate about biomedical science through various methods support formal and informal learning about biomedical science reach new audiences not normally engaged with biomedical science, as well as continuing to target existing audiences For the April deadline we will accept proposals on any topic that relates to biomedical science and the issues it raises; this is a vehicle to support topical and emerging issues. For the October deadline we only accept proposals that are related to the topic advertised on our website for the year. Projects are expected to have some biomedical scientific input either through a scientist taking on an advisory role or through direct collaboration. The Wellcome Trust is a global charitable foundation dedicated to achieving extraordinary improvements in human and animal health. Allied to this is a commitment to develop and support activities that stimulate interest, learning and dialogue on biomedical research and the questions it raises for societies. Please read the application guidelines and Grant Conditions carefully before completing the form. Please also refer to our Top Tips for Success on our website. Please submit the application form by email to SEgrants@wellcome.ac.uk. For further information please contact: Society Awards Wellcome Trust Gibbs Building 215 Euston Road London NW1 2BE T +44 (0)20 7611 5757 E SEgrants@wellcome.ac.uk SOCIETY AWARDS PRELIM 02/12 For office use only: RCM: DCM: APPLICANTS’ DETAILS Q1 Principal Applicant Full Name Title Contact address Tel Fax Email Role in project Job title Organisation Q2 Name and address of the organisation to which grant will be awarded: Q3 Please state the name and contact details of all your coapplicants: The following sections for coapplicants may be duplicated if necessary. Coapplicant 1 Name Title Contact address Tel Fax Email Role in project Job title Organisation Coapplicant 2 Name Title Contact address Tel Fax Email Role in project Job title Organisation Please provide the names and contact details for any additional project team members, indicating their role in the project 2 SOCIETY AWARDS PRELIM 02/12 PROJECT AMOUNT AND DURATION Q4 Amount sought from the Wellcome Trust (including VAT if applicable; please specify currency: GBP/Euros) Q5 Project title (no more than 10 words) Q6 Proposed start date (dd/mm/yy) Length of project (in months) PROJECT VISION Q7 Project vision Please provide a vision of what your successfully completed project will look like and what it will have achieved (no more than 250 words). PROJECT PROPOSAL Q8 Project summary Please provide a summary of your project (max 50 words). Q9 Objectives Briefly highlight the main objectives that the project will deliver (max 150 words). Q10 Project details Please give a general overview of the project (max 150 words). Q11 Outcomes Please give details of the expected outcomes of the project (max 150 words). Q12 Audience Briefly outline the target audience the project is aimed at and how they will be accessed (max 150 words). Q13 Evaluation Please outline how you will know the target audience has benefited from the project and whether is has been successful or not (max 150 words). 3 SOCIETY AWARDS PRELIM 02/12 Q14 Partnerships Please let us know about the relevant partners (individuals and organisations) who you are planning to work with to help develop the project (max 150 words). Q15 Funding Please detail the total project costs, including any funding which has already been secured (max 150 words). 4