Application Form Research Fund LLS

Application form

Project title

Abbreviated title Field of research Expected start of project, if already started please specify when it started Project duration, if already started please mention total duration and re- maining duration Total budget of the project in CHF Amount requested from the Research Fund of the Swiss Lung Associ- ation in CHF. If the amount requested is lower than the total budget, make sure the explication emerges in point 6 of this application form. Synopsis of lay summary (see document B1_Lay summary)

 Project proposal is eligible for the open procedure (Type 1)  Project proposal is eligible for the topic specific procedure (Type 2)  Project proposal is eligible for both the open and the topic specific procedure (Type 1 and Type 2)

1. Main applicant Surname, first name Date of birth Current position / function Academic degree / title Institution, address

Phone / mobile phone no. E-mail

Place and date ……………………………………...... … (Submission deadline: March 18 2016)

Signature of main applicant………………………………………….… Please sign and scan the complete application (PDF) and submit it with all necessary attachments (the Lay Summary as a document in MS-Word) via e-mail to [email protected]

2. Co-applicants 1. Surname, first name Date of birth Current position / function Academic degree / title Institution, address

2. Surname, first name Date of birth Current position / function Academic degree / title Institution, address

3. Surname, first name Date of birth Current position / function Academic degree / title Institution, address

2 3. Project description (Precise overview, max. 6 pages with the exception of bibliography references) 3.1 Research question and problem statement / scientific significance

3.2 Current state of research in the field (background, literature references)

3.3 Expertise and qualification of the applicant(s) and/or the research team regarding the field of study, pilot study if applicable.

3.4 Research objectives, justification and proof of originality

3.5 Detailed research plan and study protocol (methodological approach, design, setting, quantity structure, data availability, method of data analysis, etc.)

3.6 Schedule (Planned start and duration of the project, milestones)

3.7 Does your research project involve cooperation with another institution? Yes  No 

Please take note that in the case that the Swiss Lung Association will support your project, such agreement has to be signed prior to the signature of the agreement with the Swiss Lung Associ- ation.

3.8 Does you research project needs an approval from the Ethic Committee? Yes  No  If yes, have you already received the authorization? Yes  No  If no, have you already applied? Yes  No 

3 Please take note that in the case that the Swiss Lung Association will support your project, you have to have received such approvals prior to the signature of the agreement with the Swiss Lung Association.

3.9 Does your research project involve human and/or animal experimentation? Human experimentation: Yes  No  Animal experimentation: Yes  No 

If yes, has the Swiss Ethics Committee on research involving humans and/or the Ethics Committee for Animal Experimentation approved your request?

Human experimentation: Yes  No  Waiting for an answer 

Animal experimentation: Yes  No  Waiting for an answer 

If your project involves human and/or animal experimentation, please describe how and why?

3.10 Expected results, broader impact and its scientific relevance

Location(s) of project (institute, clinic, laboratory):

4 4. Financing (Justification of the requested amount)

Budget 1st year 2nd year 3rd year Total Salaries and social security contributions*: Name/first name, acad. degree Workload

Equipment costs, consumables Subsistence expenses (travelling costs, printing costs etc.) Additional expenditures Total

* The main applicant is not allowed to apply for his own salary, but will apply for the salary of his/her team. The salaries must include the wage-based, social security contributions which are mandatory in Switzerland: state pension scheme and invalidity insurance (AHV/IV/EO), unemployment insurance (AVIG), health and accident insurance (KVG/UVG). If applicable, enter the percentage of the employer's contributions of your institution, excluding possible further contributions such as for children or family allowances.

5 5. Resources already available for the project

Personnel - medical staff

- laboratory staff

Operational budget - of hospital

- of university

- other sources

Premises, laboratory equipment

6 6. Did you apply for project support at other funding organisations? yes no requested awarded refused pending amount (CHF) amount (CHF) - Swiss National Science Foundation (SNSF) If pending, date on which you should receive the decision

- University If pending, date on which you should receive the decision

- Other financiers: If pending, date on which you should receive the decision

Name: Name: Name: Explanations*:

*The main applicant accepts the ethical principles and guidelines of the Swiss Academy of Medical Sciences (SAMW) and the Swiss law on human research (“Humanforschungsgesetz”, SR 810.30). In case of conflicting interests, the applicant is obliged to describe the nature of the relationship and any possible material benefit or support from the relationship (self-declaration).

The Research Fund of the Swiss Lung Association does not accept any project proposal from applicants who have or have had any direct or indirect links with the tobacco industry, such as former funding from, the holding of shares in, speaking at or attending meetings organised by the tobacco industry.

Declaration

I declare that I have or have had NO relationship of any kind with the tobacco industry.

Signature of main applicant: Date:

…………………………………………….. …………………………….

7 7. Data protection principles and conditions The Research Fund of the Swiss Lung Association will treat all personal and application data confidentially. The Research Fund will pass on such data only with the written permission of the applicant or on the basis of a court order. The applicant agrees to pass the application for assessment purposes on to members of the Research Committee or to experts on behalf of the Research Committee. The Research Fund is not obliged to inform the applicant about this internal exchange of data. The applicant gives permission to the Swiss Lung Association and its Research Fund to publish the Lay Summary (see document B1) including the project title, the names of the researchers and their institutions as recipients of project grants. The applicant is obliged to indicate the support received from the Research Fund of the Swiss Lung Association LLS on all publications incl. posters, presentations, etc. in the following man- ner: “This project was supported by the Research Fund of the Swiss Lung Association.” The applicant accepts the decision of the Research Committee and will not take any legal action in this matter.

Please send the signed application as a PDF with all the necessary attachments as a zip file via e-mail to: [email protected]

Mandatory attachments:  Lay summary to be written in German or French as a separate document in MS-Word (see document B1_Lay summary)  CV of the main applicant including a list of his/her most important publications (max. 3 pages) and a separated JPG, 300 dpi. portrait photo  Short CV of the co-applicants including a list of five publications that are relevant to the project  Copies of funding decisions by the SNSF or other organisations concerning this project

Optional attachment:  Letter of support (mentoring)