Grant for the study of responsible alcohol/beer
consumption in a healthy lifestyle
Application Form
Applicant’s name:
Current position:
Personal details
Title:
First Name:
Address:
City:
Telephone:
Mobile:
Email:
Last Name:
Post Code:
Check (x) if you will be registered as a student / PhD student on the 1st March 2014:
Student (HBO): ( )
Student (university): ( )
Department:
Institution:
Supervisor’s name:
Email:
Project Title:
Keywords: (maximum of 5)
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2
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5
Project Outline:
Background (maximum 250 words).
(Short introduction about the area of interest).
Objective (maximum 150 words).
PhD student: ( )
(State the main study objective, clearly defining the hypothesis or question you want to
answer through this research, and any secondary objectives).
Methodology (maximum 600 words).
(Describe the study design, population, sample size, variables, measurements and
statistical analysis plan).
Knowledge utilisation (maximum of 150 words)
(Describe in what manner the output of the proposed research can lead to new insights
or applications, specifically focusing on health professionals like dieticians, weight
consultants and GP assistants).
Key references (maximum of 5 key references).
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2.
3.
4.
5.
Budget:
Please detail the concepts and costs to be covered by The Dutch Beer Institute grant
(up to maximum of € 5,000)
Timetable:
Please detail timelines of the study (to be finished on March 2015 or before)
Start date:
Completion date:
Ethics Committee approval:
Granted:
Yes/No
If no, will Ethics Committee approval be sought after assignment of the grant?
Yes/No
Before the start of the study ethical approval needs to be obtained from an accredited Dutch MedicalEthical Review committee. In addition subjects will give their written informed consent before the
start of the study.
Commitment:
I declare that the above information is, to the best of my knowledge, correct.
If this research grant is awarded to me, I will write a report at the end of the
research and send it to The Dutch Beer Institute. I declare that any publication
arising from the research undertaken under the auspices of this grant will
acknowledge the financial support of the The Dutch Beer Institute and a courtesy
copy of any manuscript accepted for publication will be sent to the The Dutch Beer
Institute. The final report as well as any manuscripts arising from this research will
be endorsed by the Supervisor.
Date:
Signature:
(Electronic signatures are accepted)
Additional documents required:
Please send this application form and the following documents in English in pdf
format to info@kennisinstituutbier.nl:
- Curriculum vitae of the applicant, including degree certificates.
- Curriculum vitae of the project supervisor.
- The Supervisor Support Form (download from www.kennisinstituutbier.nl/grant)
(documents not using this template will not be considered)
Application timeframe ends on the 14th of May 2014 at 12 midnight.
Incomplete applications will not be considered.