CHSS Research 2014-15 Fellowship application form

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CHEST HEART & STROKE SCOTLAND
RESEARCH FELLOWSHIP 2014/15
Applications are invited for a Research Fellowship aimed at undertaking a research programme of
clinical or basic scientific work related to heart disease, stroke and respiratory illness. The CHSS
Research Fellowship is worth a maximum of £120,000, and is open to doctors completing their
general professional training at a Scottish hospital, preferably already with their MRCP or equivalent.
Applications should be made jointly by the applicant and supervisor, and must be authorized by the
Head of Department and administering authority.
Applications for part-time Fellowships will be considered.
Completed applications must be returned to Chest Heart & Stroke Scotland, Rosebery House, 9
Haymarket Terrace, Edinburgh EH12 5EZ, no later than 10th October 2014, for consideration at
the next meeting of the Research Funds Committee.
Applications will only be considered from those living and working in Scotland.
CHSS does not support projects involving the use of animals.
Applicant:
Degrees:
Date of birth:
Contact telephone number(s):
Email:
Present appointment:
Address for correspondence:
Name of Supervisor:
Position:
Address for correspondence:
Telephone:
Email:
Title of proposed research:
Place of intended research:
Proposed start date:
Proposed end date:
The following information should be provided:
1.
Purpose of proposed investigation
2.
Background to proposed research programme
3.
Plan of investigation – details of experimental design and methods, with outline timetable
4.
Anticipated outcomes, including direct or indirect benefits to patients
5.
Summary of financial requirements
(Items 1 – 5 inclusive should be no more than 1,200 words inclusive. Please include a word count.)
6.
Short description of proposed research and significance of expected outcomes in layman’s terms, i.e.
suitable for general publication (not more than 100 words).
A CV for the applicant is required (summarized on two sheets A4), which should include details of relevant
publications, directly relevant research experience, and training undertaken or to be undertaken.
DECLARATION
“I attach a full statement of the intended research programme, together with relevant employment details,
equipment, expenses, etc., and a statement from the Departmental Head in support. I will inform Chest Heart
& Stroke Scotland of any change in employment or finance that affects this application. If it should be
successful, I agree to submit appropriate reports to the Research Funds Committee. If accepted, I agree to
submit evidence that this project has been approved by the local Ethics Committee.”
Signature APPLICANT
Date
Signature SUPERVISOR
Date
CHSS Research Fellowship 2014/2015
2
This application should be submitted by/through (i) the Head of Department, and (ii) the officer who will be
responsible for administering any grant that may be awarded.
HEAD OF DEPARTMENT
Name:
Title:
Institution:
Address:
Phone number:
Email:
ADMINISTERING OFFICER
Name and initials:
Title:
Address:
Phone number:
Email:
“I confirm that I have read this application and, if granted, the work will be accommodated and administered in
the Department/Institution in accordance with Chest Heart & Stroke Scotland’s regulations. The staff grading
and salary quoted are correct and in accordance with the normal practice of this institution.”
Signature: HEAD OF DEPARTMENT
Date
Signature: ADMINISTERING OFFICER
Date
WHEN SUBMITTING, PLEASE SEND ORIGINAL PLUS ELEVEN COPIES OF THIS APPLICATION
CHSS Research Fellowship 2014/2015
3
FIRST YEAR
SECOND YEAR
THIRD YEAR
£
£
£
£
£
EQUIPMENT
(all items must be listed and costed)
£
£
EXPENSES –
e.g. reagents, materials
(all items must be listed and costed)
£
£
OTHER – e.g. travel
Open Access: CHSS will
meet the actual charges
for one main article
arising from the study,
not exceeding £2,500
(all items must be listed and costed)
£
£
TOTAL £
£
SALARY
£
NI and Super.
Point on salary scale
Hours per week
Name, age and qualification
APPLICATION TOTAL
(not exceeding £120,000)
NB Salary will be paid by employing authority, who will be reimbursed by CHSS
CHSS Research Fellowship 2014/2015
4
£
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