Application for Pump Priming

Marie Curie Research Grants Scheme Outline Application Form

Please refer to the associated guidance notes on our website before completing the application form

Please complete in Arial, font size 11 and forward completed application forms (saved as a Word document under the full name of the Principal Investigator(s)) to [email protected]

Boxes will expand as needed and more rows can be added.

1. About you

For PIs and CoIs For PIs and only: CoIs only: Role in this application Title(s) Number of hours per Does your Are you within (Principal (Principal Applicant(s) week contributing to current 8 years of Surname Institution Investigator / Investigator(s) forename this research project employment completion of Co-Investigator / first) (hrs) cover the entire your PhD or Collaborator, duration of the equivalent etc.) proposed study qualification (yes/no)? (yes/no)?

Institution (administering award if approved) Department accommodating project (and Institution if different to above) Principal Investigator’s Principal Investigator’s email Tel. No.

2. About your project Project title

Project type (e.g. trial, feasibility study, systematic review etc.) Proposed start date (dd/mm/yy) (Please note that your start date will be after the conclusion of the full application stage. Please refer to the associated guidance notes for more information) Proposed duration (in months)

Total support requested (£)

1 3. Information related to funding Please answer the following questions and select the appropriate box(es) below Are you a PI in Scotland?

Does your proposal relate to people with Motor Neurone Disease? Does your proposal relate to people with any terminal primary brain tumour? Does your proposal relate to one of Marie Curie’s five highlighted research areas? None of the above Where did you hear about the current call for applications to the Marie Curie Research Grants Scheme

4. Remit Please explain how the proposed study relates to palliative and end of life care and the themes of the call. In particular, please detail which of the PeolcPSP research questions and/or research recommendations are addressed by the proposal and how they are addressed. Please refer to the associated guidance notes for more information regarding the themes of the call (strictly limited to 500 words)

5. Key words Please list up to 6 key words that you think best describes and categorises your proposed work

6. Abstract Please write an abstract of the work planned in this proposal (strictly limited to 700 words). This should include, but is not limited to, the background/scope of the study, its aim/research question(s), the methodology employed and its proposed findings

Word count 2 7. Lay abstract Please write a lay abstract understandable for the general public. It is vitally important to describe the work you plan to do in clear language which our stakeholders will find informative (strictly limited to 300 words)

Word count

8. Impact statement suitable for a lay audience Please state how the proposed research is likely to impact patients with terminal illnesses and/or their carers/communities/families/friends, including the potential timeframe to benefit, both within and beyond the lifetime of the study. For example, how would the proposal have the potential to impact the work of Marie Curie etc. (strictly limited to 250 words)

9. Information related to previous submission Does this application follow on from a previously funded Marie Curie award?

If yes, please give the name and reference number of the award. Is this a resubmission in any part of an application to Marie Curie?

If yes, please give the date, funding stream and outcome of the original submission, and explain how the previous feedback received has been addressed in this current application (strictly limited to 400 words)

10. How does your proposal fit with the funding criteria for this call? Applicants are requested to explain how their proposal fits with a number of funding criteria. This section will be used to assess the strategic fit of the proposal with the aims of the charity. Successful applicants will be invited to submit a full proposal. Please consider the criteria below and explain how your project addresses each of them within the word limits specified. The potential to improve palliative and end of life care for people with a terminal illness and/or their families, friends, carers and communities (strictly limited to 150 words)

3 Evidence of a demonstrable need for research in this area. Please highlight any relevant systematic reviews and/or all past/current trials, if applicable (strictly limited to 150 words) The potential national/international impact of the proposed research (strictly limited to 150 words)

The active engagement of PPI principles and processes in all stages of the research from planning through to dissemination (strictly limited to 150 words)

The potential of study results or interventions to be generalisable and applicable throughout the UK (strictly limited to 150 words)

A clear research plan and description of methodology to be employed. For feasibility studies, include the outcome measures and describe how and from whom the full trial could be funded (e.g. the National Institute for Health Research) (strictly limited to 300 words)

The suitability of the PI(s), research team and collaborators to carry out the proposed research, including their track record and expertise. Please also include the involvement of any Clinical Trials Unit(s), if applicable (strictly limited to 300 words)

Dissemination and knowledge transfer plan, including and beyond peer reviewed publications (strictly limited to 150 words)

11. Finance Summary Please provide a simple financial summary for the whole proposed award period (strictly limited to one A4 page). Please refer to the guidance notes for more information regarding eligible costs. Year Staff posts Staff costs (£) FTE (%) Running expenses Year total (£) (e.g. Yr 1, including Equipment Yr 2 etc.) and publication costs (£)

Total costs applied for (£)

Justification of costs for each item mentioned (limited to 500 words) 4 12. References Please include any references cited within the application. Please give the citation in full, including the title and all authors. Shortened references will not be accepted. Please note that the references will not contribute to any stipulated word counts.

13. Acceptance of regulations and conditions

 I/We have read the Guidelines for applicants, Themes of call document and Marie Curie’s Terms and Conditions  I/We shall be actively engaged in, and in day-to-day control of, the project.

Signature of Principal Investigator(s) (Electronic signatures are accepted)

The preliminary application phase also requires the signature of the Head of Department where this proposal will be accommodated.

Signature of Head of Department (Electronic signatures are accepted)

Name and initials

Address and telephone number

Email address