Insert Additional Rows As Required

Application ID: CIA Surname:

Supplementary Questions RAH SPF applications for Near Miss NHMRC Project Grants commencing in 2018 SPF Funds The RAH Special Purpose Funds Committee (Private Practice) has committed to funding clinical project grants commencing in 2018 to support clinically relevant research within the South Australian Health Biomedical Precinct. Applications must have a bonafide link to a RAH Private Practice contributor(s) who must be a CI or AI on the grant.

IMPORTANT NOTE TO APPLICANTS: Please check the RAH Research guidelines for further information.  Applications to the RAH Research Committee comprise:  A copy of the NHMRC RGMS application, that was submitted to the NHMRC in accordance with their guidelines, and  A copy of the NHMRC score & assessors comments  Supplementary Questions document

 The same application ID must be used on both the NHMRC application and the Supplementary Questions document. Please name your document [application ID]_SuppQs_[CIA Surname] Eg: 190919_SuppQs_Smith  Closing Date: COB December 1 2017  Please insert application ID and CIA surname in the header  Please use Times New Roman 12 font for all responses  For Yes / No answers, please place an X to the left of the preferred option

1. Chief Investigator A – contact details (for correspondence)

Application ID Name Department Institution Address Suburb State Postcode Phone Email

RAH SPF Private Practice Contributor (CI, AI) Name:

2. Administering Institution Please include name and institution of the Research Admin Officer (RAO) nominated in your original NHMRC application (University of Adelaide/University of South Australia/SAHMRI/CALHN RAH/SA Pathology)

Name of RAO

Revised 4/5/17 1 Application ID: CIA Surname:

Institution Phone No Email

3. Scientific Title of project

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INVESTIGATORS

4. Please list all Chief Investigators and Associate Investigators who will be named on the application, and the Institution they are located in.

Chief Investigator(s) Institution (Title, First name & Surname)

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Associate Investigator(s) Institution (Title, First name & Surname)

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5. Is the list and/or sequence of Investigators on the SPF Near Miss application the same as on the NHMRC application form?

Yes  Go to Question 6. No  a) Please briefly explain why the list of investigators has changed b) If there are Chief Investigators named on this application that are not named on the NHMRC application, please attach to the end of this document, one page of Track Record information and list of publications for the last 5 years

CLINICAL RELEVANCE TO RAH

6. Relevance to the causes, diagnosis, treatment or prevention of disease at the

Royal Adelaide Hospital Please include information on the relevance to the Royal Adelaide Hospital in your response, including how you might progress the results of your work and its translation into clinical practice. (2 page maximum)

BUDGET AND SCOPE OF RESEARCH

7. Scope of Research What modifications to your project will be required in order for it to fit with the level of funding being offered by the SPF? Please provide information about the aims that will be retained and the aims that will be removed due to the reduced level of funding and/or reduced number of years. (1 page maximum)

BUDGET:

Named Person Level 2018 $ $ $ $ Equipment $ Maintenance $ Total

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RESEARCH SUPPORT

8. List all other Research Grants held by any of the Chief Investigators during the 2018 period. Application ID Chief Investigators, Project Title, Year(s) grant held (if known)

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