Application for Project Grant

T H E H A W K E S B A Y M E D I C A L R E S E A R C H F O U N D A T I O N I N C . P.O. BOX 596 NAPIER NEW ZEALAND www.hbmrf.org.nz

APPLICATION FOR PROJECT GRANT

Date of First Renewal Application Application Application

Title of Project:

Project Commence Date:

Duration:

Name of Applicant:

Mailing Address:

Telephone No:

Fax No:

E-mail

Budget $

Salaries - Applicant:

Professional/Scientific:

Other:

Equipment:

Working Expenses:

TOTAL:

Preferred Date for Receiving Funding: ABSTRACT (up to 150 words) PROPOSED INVESTIGATION

Single-spaced typing on supplementary pages, if necessary, under the following heading:

Reasons for undertaking research, including background List aims Timeline indicating how the research will be conducted

RESEARCH DESIGN: - Methods and Experimental Approach

Hypotheses Subjects Methodology – comment on reliability and validity Data analysis Reporting

SCIENTIFIC/HEALTH SIGNIFICANCE a) Anticipated health benefit b) Significance of research c) Dissemination of results d) Special relevance to Hawke’s Bay

RELEVANT PREVIOUS WORK BY APPLICANT: - And/Or Associates a) Qualifications and experience b) Publication of previous work c) Grants received for previous work

MAORI HEALTH PROPOSALS a) Significance and contribution to Maori health issues b) Potential of project to enhance research by Maori for Maori SALARIES, EQUIPMENT AND EXPENSES

SALARIES:

List the proposed roles of each worker, salaried or honorary, and give details of any salaries required.

EQUIPMENT:

List,with nature of equipment, purpose, cost, availability, alternatives and disposability.

WORKING EXPENSES:

Materials, consumables, computer charges, postage, maintenance of equipment, travel, other expenses

FACILITIES:

Indicate what premises and other facilities are available and whether approval has been obtained for the use of such facilities.

OTHER CONSIDERATIONS

OTHER SUPPORT:

What other support, financial or otherwise is available for the project. ETHICAL CERTIFICATES:

Any project involving experimentation with human subjects or animals requires approval from appropriate hospital or animal ethical committees. Any research project to be carried out within the Hawke’s Bay District requires the approval of the Central Ethics Committee, Level 2, The Terrace, PO Box 5013m, Wellington. Phone: 04 4962405 Fax: 04 4962191.

REFEREES:

List names and contact details of two referees who may be approached by the Foundation.

BIOGRAPHICAL INFORMATION

Please supply this information on separate pages for the applicant and all other professional or scientific workers

Position:

DEGREES, QUALIFICATIONS, CONFERRING INSTITUTION, YEAR CONFERRED

ACADEMIC OR RESEARCH EXPERIENCE

PUBLICATIONS (Send copies of major papers) WHAT PERCENTAGE OF YOUR WORKING TIME WILL BE DEVOTED TO THIS PROJECT?

(It is acknowledged that information related to any Research Project: name, title, duration, funding grant, may be used for publicity and for other research purposes.)

Date: ______Signature: ______

Applications can be submitted to: “The Secretary”, P.O. Box 596, Napier, or e-mailed to “The Secretary” at : hbmrf.org.nz or [email protected]

Judith M Baxter (Secretary)

Phone: 06 8799199/fax Mobile: 0273 135 135