National SpR/SR Academic Fellowship Programme 2014
Supplementary Application Form
Please note that a complete NSAFP application consists of:
1. A supplementary NSAFP application form
2. A copy of your application form and associated documentation for the HST Training
Programme
3. A letter of support from the nominated academic (research ) sponsor
4. A recent Curriculum Vitae
NOTE: It is the responsibility of the candidate to contact the relevant Training Body to ensure
that all documentation is received on time and in the correct format. All documentation should
be submitted to the Training Body on or before November 29th 2013.
Applicant Details
Name:
Title/Position:
Medical Council
Registration Number:
Correspondence
Address:
Tel Number:
Fax Number:
Email Address:
NSAFP 2014 Supplementary Application Form
Training Details
Are you currently enrolled in a HST training programme (Y/N)
If ‘Yes’, list which Training Body and
at what stage you are at in your
training at the time of application
If ‘No’, list which Training Body you
have applied to this year
Specify the number of years of
clinical specialist training remaining
as at July 14th 2014 before eligibility
for CCST
Current employment position (Grade
& Specialty):
Current clinical training location at
time of application:
Current point on salary scale:
(specify scale, i.e. SHO / Reg /
SpR/SR and point on scale)
Current Training post Number:
Research experience to date
Please provide details of any research projects and/or other relevant research experience
that you have undertaken or are undertaking. Indicate your level of involvement and your
exact role in the research team.
Academic/research career plans
Please state your reasons for applying for this academic clinical fellowship, indicating your
medium and long term career goals in relation to an academic research career in this
specialty area.
Academic Sponsor details
Name:
Title/Position:
Department:
Address:
Tel Number:
Fax Number:
Email Address:
Provide a brief description of the academic sponsors’ current programme of research and
how this relates to this proposed study:
NSAFP 2014 Supplementary Application Form
Please indicate the number of research students previously/currently sponsored to Masters
and PhD level by the academic sponsor:
List the academic sponsors’ publications relevant to this proposal (maximum 20):
Academic and Host Institution for research award
Please provide details of the Academic institution where you propose to register for your
PhD and which will act as the host institution to administrate the research grant awarded
by the HRB.
Research training and environment
Please provide details of the institutions where the research will be conducted.
Briefly describe the infrastructure and other supports available at these sites. Describe
proposed plans for generic research skills training and any additional specialist training, if
required, throughout the fellowship.
Collaborators
Please fill in the following table for each collaborator associated with the programme.
If more tables are required please copy and paste as necessary.
Collaborator 1
Name:
Department:
Institution:
Email:
Present position:
Please briefly describe how this collaborator will contribute to the research project
NSAFP 2014 Supplementary Application Form
Outline of the Research Project [Maximum 4 pages]
Research project
Please briefly outline below the background and relevance of research area, the research
questions you propose to address during your PhD and the general methodological
approach you are proposing to use.
Please note that if successfully recommended for a fellowship, you will be requested to
provide a more detailed research proposal for submission to the HRB, which will be peer
reviewed internationally prior to the release of the funding supporting the research-related
costs.
Project title:
Abstract:
Background to the area and current knowledge
Describe the background to the research proposal and detail the size and nature of the
issue to be addressed. Include evidence from the literature and give references to any
relevant systematic reviews. Also summarise the importance of the proposed research
and describe its anticipated outputs, outcomes and impact, indicating the anticipated
timescale for any proposed benefits to be realised
Aim and Objectives and Methodological approach
Briefly describe the overarching high level aims of the project and then outline the
specific research questions which this work will address. Briefly describe general
methodological approaches you intend to use.
Relevance and impact of proposed research on health, health outcomes and clinical
practice:
Sponsorship arrangements
Please describe the supervisory and mentoring arrangements during the duration of
the fellowship programme addressing the integration of clinical and research
training in order to achieve the CCST and PhD at the end of the Fellowship
Programme
NSAFP 2014 Supplementary Application Form