Peer Award Application Form
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PEER AWARD APPLICATION FORM
For applications to the SRPe Pools Engagement in European Research (PEER) fund, please complete the application form below and submit it to Susan Hamilton, SRPe Project Manager, at [email protected].
The submission deadline is 5pm on Wednesday 31st January 2018.
1.Part 1 – Main Applicant Details
Institution Name
Applicant Name
Position
School / Department
Contact Address
Telephone
Part 2 – Academic Partners (within SRPe)
Institution Name
Contact Name
Position
School / Department
Contact Address
Telephone
For additional partners please add separate boxes. Part 3 – Academic Partners (non-SRPe)
1 Institution Name
Contact Name
Position
School / Department
Contact Address
Telephone
For additional partners please add separate boxes.
2.Part 4 – Industry Partners
Company Name
Contact Name
Position
Contact Address
Telephone
Website
SME (Y/N)
For additional partners please add separate boxes.
3.Part 5 – Details of the Proposed PEER Activity
Activity Start Date
Activity End Date
PEER Activity Title (SRPe will use this title for external communications & reporting)
2 Brief description of the PEER Activity (Max 200 words.) (Attach any relevant documents as Appendices)
Brief Description of Planned Outputs / Outcomes (Max 200 words)
Related European Call / Project / Programme Title (if already identified / applicable / relevant)
Brief Description of the European Project / Programme (Max 200 words)
Which SRPe Strategic Theme(s) does the PEER Activity align with?
How will the participating universities and / or the wider SRPe pool benefit from the PEER Activity? (Max 200 words)
How will the participating industrial partners benefit from the PEER Activity? (Max 200 words)
What do you anticipate will be the wider impact of the PEER Activity? (Max 100 words)
What further steps, if any, do you anticipate taking following on from the PEER Activity? (Max 200 words)
3 Any additional comments to support your application? (Max 100 words)
4.Part 6 – Delivery Plan
List all sub-activities and deadlines.
The deliverables should include an End of Activity Report, which must be submitted no later than 31st August 2018.
# Sub-Activities Deadline
1.
2.
3.
4.
5.
5.Part 7 – Costs
Please provide a detailed breakdown of the estimated costs (in GBP) of the activity below:
Staff Costs
List all the individuals (for all SRPe university partners) who will be working on this project, together with the number of planned hours and overall day rate (direct salary + NI + pension). The day rates should be normal university partner rates. Note that the maximum eligible day rate is £500 pd.
Name Position / Institution No. Hours Day Rate (£)
4 Other Costs
List below all of the non-staff costs (such as travel, subsistence and meeting costs) indicating whether they will be incurred by an SRPe University, or another organisation in the consortium. Please note travel and subsistence costs for non-academic partners is ineligible.
Item or activity SRPe Non-SRPe Industry Total per University (£) University (£) Partner (£) activity (£)
Sub-Total (£)
Total Funding Requested
Total funding requested from SRPe under this PEER Activity application (staff costs and other costs).
Total amount requested from SRPe (£)
5 6.Part 8 - Data Protection
SRPe will use information provided on the application form for the purpose of processing the application to assess its suitability for support. If the application is successful, SRPe will use the information for administration and management purposes, including carrying out appropriate checks, audits and marketing.
Part 9 - Applicant Signature
Please ensure the application form is signed by an authorised institutional approver before submission. Applications submitted without institutional sign off will not be eligible for funding.
Institutional Approval
Institution Name
Approver Name
Job Title
Signature
Date
Applicant Signature
Date
6 7.PEER & PECRE Equality and Diversity Monitoring Form
The Scottish Research Partnership in Engineering is committed to ensuring that applicants and employees are not subject to direct or indirect discrimination based on protected characteristics of age; disability; gender reassignment; marriage and civil partnership; pregnancy and maternity; race; religion or belief; gender; and sexual orientation; or any other irrelevant factor. We would be grateful if you would complete this form and return it with your application. The information will not be used as part of the selection process itself and will be held in compliance with The Data Protection Act 1998. The information contained in this form will be used solely for statistical purposes. Your co‐operation in completing and returning this form is appreciated.
Basic details Response Name Institution
What is your age? Response 16-24 25-34 35-44 45-54 55-64 65+
What is your gender? Response Male Female Other Prefer not to say
Is your gender identity the same as the gender Response you were originally assigned at birth? Yes No If ‘No’, specify if you wish Prefer not to say
7 Ethnic Origin: The options reflect the census ethnicity classifications used throughout the UK and allow comparative statistics to be derived both within and out with the sector. Tick the most appropriate box to indicate your ethnic origin.
White – British White Scottish
Other White background Asian or Asian British – Indian Asian or Asian British – Chinese Pakistani Black or Black British – Black or Black British – African Caribbean Mixed – White and Black Mixed – White and Asian African Other Mixed background Not known Other Not Listed Above
What religion, belief or faith do you belong to? Response None Christian: Church of Scotland Christian: Roman Catholic Christian: Other Christian (please specify) Muslim Buddhist Sikh Jewish Hindu Humanist Another religion or belief (please specify) Prefer not to say
How would you describe your sexual orientation? Response Bisexual Gay man Gay woman / Lesbian Heterosexual / straight Not sure Other (please specify)
Prefer not to say
What is your legal marital or same sex partnership Response status? Single Married / Civil Partnership Separated Divorced / dissolved Civil Partnership Co-habiting / in a relationship
8 What is your legal marital or same sex partnership Response status? Widowed / surviving partner from Civil Partnership Prefer not to say
Parental Requirements Please select if you are: On additional paternity On adoption leave On maternity leave leave Pregnant Prefer not to say Not applicable
Do you have a disability? Response I have a disability I have no disability Prefer not to say
Thank you for taking the time to complete this form.
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