<p> Office use</p><p>Nurses Board of Victoria Legacy Limited Grants and Fellowships</p><p>MAJOR GRANTS APPLICATION AND GUIDELINE FORM 2017 □ Mona Menzies Postdoctoral Research Grant □ Ella Lowe Grant</p><p>□ Major Research Grant □ Rosemary Kelley Research Fellowship</p><p>Applications close at 4pm Friday 15th September 2017</p><p>OBJECTIVE To enhance nursing and midwifery practice and knowledge in Victoria</p><p>ELIGIBILITY To be eligible for any of the Nurses Board of Victoria Legacy Limited (NBVLL) grants and fellowships, applicants must be currently registered with the Nursing and Midwifery Board of Australia. Funding under NBVLL is open to Nurses and Midwives whose principal place of practice is Victoria. Eligibility criteria for each of the grants is outlined below. </p><p>FUNDING Funding is normally for a period of 12 months. Extensions must be applied for and may be approved by the NBVLL Board of Directors. </p><p>PREVIOUS APPLICANTS Those who have previously received funding through NBVLL must wait two calendar years before being eligible to apply again. Applicants who have previously been unsuccessful may re-apply in the following round, providing they still meet the eligibility criteria. </p><p>SUBMISSION OF APPLICATIONS It is preferred that applications be typed, however hand written applications will be accepted. Completed forms must be printed, signed and forwarded to:</p><p>NBVLL Secretariat PO Box 327 WENDOUREE VIC 3355</p><p>Applications postmarked on or before the closing date will be accepted. It is recommended that applicants keep a copy of their application until they are notified that it has been received by the NBVLL Secretariat. Notification of receipt will be sent via email. </p><p>SELECTION PROCESS All eligible applications will be reviewed based on the information provided in the application form. Grants worth less than $20,000 will be reviewed by at least two reviewers and grants worth $20,000 and over will be reviewed by three reviewers. If further information is required in order to assess your application, you will be contacted by the NBVLL.</p><p>NOTIFICATION PROCESS</p><p>Nurses Board of Victoria Legacy Limited Grants and Fellowship 1 Application Form 2018 Applicants will be notified of the outcome of their submission by mail by 31st December 2017. The decision of the NBVLL Board is final and no correspondence will be entered into. Applicants may request to be provided with feedback from the review process. </p><p>CONDITIONS Please see terms and conditions at the end of this application</p><p>Please indicate the type of grant you are applying for: If you require any assistance in completing this application form, please call 1800 559 136 </p><p>MONA MENZIES POSTDOCTORAL RESEARCH GRANT Value: Up to $50,000 The purpose of this grant is to facilitate postdoctoral research that relates to improving health outcomes across a number of areas, and/or changing the scope of practice in nursing and midwifery. Registered nurses and/or midwives with a doctoral qualification who propose to conduct research will be considered, provided the research is related to the Victorian public. Grants are not available for research projects undertaken as part of studies towards an academic award.</p><p>ELLA LOWE GRANT Value: Up to $50,000 The purpose of this grant is to facilitate research, education or program evaluation in any clinical setting that has the potential to lead to better patient outcomes. This grant is available to any registered nurse and/or midwife who is registered with the Nursing and Midwifery Board of Australia who proposes to conduct activities as outlined above. Grants are not available for research projects undertaken as part of studies toward an academic award.</p><p>MAJOR RESEARCH GRANT Value: Up to $20,000 The purpose of this grant is to facilitate research that relates to improving health outcomes across a number of areas, and/or changing the scope of practice in nursing and midwifery. This grant is available to any registered nurse and/or midwife registered with the Nursing and Midwifery Board of Australia who proposes to conduct research as outlined above. Grants are not available for research projects undertaken as part of studies toward an academic award.</p><p>ROSEMARY KELLEY RESEARCH FELLOWSHIP Value: Up to $10,000 The purpose of the Rosemary Kelley Fellowships is to support registered nurses undertaking research to advance knowledge and skills in haematological malignancies (leukaemias, lymphomas, myeloma and related blood disorders) and other forms of cancer. Grants are not available for research projects undertaken as part of studies towards an academic award.</p><p>A PERSONNEL DETAILS Chief Investigator/Project Lead A Please note that this person will be considered the contact person for the grant and will be understood to be acting for, and in concurrence with, all chief investigators.</p><p>Title: Given Name: Surname: </p><p>Postal Address: </p><p>Suburb: State: Postcode: </p><p>BH Tel: Mobile: </p><p>Nurses Board of Victoria Legacy Limited Grants and Fellowships 2 Application Form 2018 Email address: </p><p>NMBA Registration ID Number: </p><p>Project Team Members B Title: Given Name: Surname:</p><p>C Title: Given Name: Surname:</p><p>D Title: Given Name: Surname:</p><p>In signing this section, you certify that all details given in this application are true and correct at the time of applying Signature of Chief Investigator Signature A Date</p><p>Signatures of Project Team members Signature B Date Signature C Date Signature D Date</p><p>Nurses Board of Victoria Legacy Limited Grants and Fellowships 3 Application Form 2018 Certification by Head of Department or School I certify that appropriate general facilities will be available to the applicant if successful. I am prepared to have the project carried out in accordance with the Nurses Board of Victoria Legacy Limited conditions. </p><p>Title Given Name Surname</p><p>Department</p><p>Signature Date</p><p>Certification by Head of the Administering Institution/Organisation for grant funds I certify that this request satisfies all the requirements of this institution, and that this institution has established administrative processes for assuring sound ethical practice in relation to disbursement of the grant funds.</p><p>Title Given Name Surname</p><p>Appointment</p><p>Institution</p><p>ABN </p><p>Signature Date</p><p>Certification by Ethics Committee Please select either (a) or (b) and sign. This certification is the responsibility of the applicant. </p><p>(a) I certify that the application has been referred to the relevant Ethics Committee(s), the report(s) of which is/are included with this application. (b) I certify that the application will be referred to the relevant Ethics Committee(s), the report(s) of which will be forwarded to the NBVLL Officer. </p><p>Signature Date</p><p>Nurses Board of Victoria Legacy Limited Grants and Fellowships 4 Application Form 2018 Chief Investigator/Project Lead details</p><p>A Title Given Name Surname</p><p>Current Appointment Direct Phone No.</p><p>Current Work Address</p><p>Email</p><p>Most recent academic qualification e.g. PhD Year</p><p>Conferring Institution</p><p>Percentage of working time to be devoted to:</p><p>This project % All other research projects % Should investigator expect to be absent during the Project Grant period complete the following: Period of absence Reason</p><p>Signature Date</p><p>Project Team member details</p><p>B Title Given Name Surname</p><p>Current Appointment Direct Phone No.</p><p>Current Work Contact Address</p><p>Email</p><p>Most recent academic qualification e.g. PhD Year</p><p>Conferring Institution</p><p>Percentage of working time to be devoted to:</p><p>This project % All other research projects % Should investigator expect to be absent during the Project Grant period complete the following: Period of absence Reason</p><p>Signature Date</p><p>Nurses Board of Victoria Legacy Limited Grants and Fellowships 5 Application Form 2018 Project Team member details</p><p>C Title Given Name Surname</p><p>Current Appointment Direct Phone No.</p><p>Current Work Contact Address</p><p>Email</p><p>Most recent academic qualification e.g. PhD Year</p><p>Conferring Institution</p><p>Percentage of working time to be devoted to:</p><p>This project % All other research projects % Should investigator expect to be absent during the Project Grant period complete the following: Period of absence Reason</p><p>Signature Date</p><p>Project Team member details</p><p>D Title Given Name Surname</p><p>Current Appointment Direct Phone No.</p><p>Current Work Contact Address</p><p>Email</p><p>Most recent academic qualification e.g. PhD Year</p><p>Conferring Institution</p><p>Percentage of working time to be devoted to:</p><p>This project % All other research projects % Should investigator expect to be absent during the Project Grant period complete the following: Period of absence Reason</p><p>Signature Date</p><p>Nurses Board of Victoria Legacy Limited Grants and Fellowships 6 Application Form 2018 B RESEARCH/PROJECT PROPOSAL</p><p>1. Project title (maximum 25 words) </p><p>2a. Plain language statement (To be provided in 100 words or less) </p><p>2b. Keywords (Please provide up to five nursing area keywords related to your application. Suggestions include – aged care, clinical, child and adolescent health, community health, family care, Indigenous health, mental health, midwifery, primary health care or other).</p><p>1. 2. 3. </p><p>4. 5. </p><p>3. Institution where project will be carried out (if more than one, indicate the primary institution)</p><p>4. Administering institution (full name and address required)</p><p>5. Has any other funding been sought for this activity? Yes No </p><p>If yes, please detail the funding source (name and address of each agency) and the amount requested.</p><p>6. Have you or members of the team previously been awarded a Nurses Board of Victoria Legacy Limited grant or fellowship? Yes No </p><p>If yes please state year, name of grant or fellowship, and activity title.</p><p>Nurses Board of Victoria Legacy Limited Grants and Fellowships 7 Application Form 2018 7. Project/Research Plan Outline The project should be completely described on this and the following page. Do NOT exceed the two pages provided, if more than two pages are used the application will not be considered. The font must not be smaller than 10pt. Complete this section using the following headings: a) Background and need for the project including its significance to the Nurses Board of Victoria Legacy Limited. b) Aims and/or hypothesis. c) Timeline for major activities.</p><p>Nurses Board of Victoria Legacy Limited Grants and Fellowships 8 Application Form 2018 7. Project/Research Plan Outline continued</p><p>Nurses Board of Victoria Legacy Limited Grants and Fellowships 9 Application Form 2018 C BUDGET For any items that are GST applicable, please quote GST inclusive amounts.</p><p>Cost for Cost for following year Total Cost First year (if appropriate)</p><p>A Personnel </p><p>Equipment (this should not exceed B $500) and materials </p><p>C Data Processing </p><p>D Travel </p><p>Stationery, duplicating, printing, E postage etc. </p><p>Accommodation, laboratory F facilities, etc. </p><p>G Administrative costs of Institution </p><p>H Miscellaneous </p><p>TOTAL $ $ $ </p><p>Nurses Board of Victoria Legacy Limited Grants and Fellowships 10 Application Form 2018 D JUSTIFICATION OF BUDGET ITEMS The information provided must be sufficient to enable proper assessment of your application.</p><p>Nurses Board of Victoria Legacy Limited Grants and Fellowships 11 Application Form 2018 E RELEVANT REFERENCES TO THE WORK OF OTHER EXPERTS No more than one page of references should be provided. These must include a brief synopsis of content.</p><p>Relevant </p><p>Nurses Board of Victoria Legacy Limited Grants and Fellowships 12 Application Form 2018 F REFERENCE TO YOUR WORK IN THE FIELD IN SUPPORT OF THIS APPLICATION E.g. publications, previous research and clinical practice. Refer to other members of the research team if applicable. No more than one page should be provided.</p><p>Nurses Board of Victoria Legacy Limited Grants and Fellowships 13 Application Form 2018 G HOW DID YOU HEAR ABOUT NBVLL GRANTS AND FELLOWSHIPS?</p><p>Website NBVLL website Australian College of Nursing Department of Health Facebook Google</p><p>Publication/Newspaper ANF Journal Nursing Review Geelong Advertiser</p><p>Other Direct Email Manager Colleague/Friend Workplace </p><p>TERMS and CONDITIONS Original receipts will only be accepted. NBVLL grants and fellowships are only for the named recipient. Alcoholic beverages, or incidentals otherwise claimed via salary sacrifice will not be reimbursed. The NBVLL Board of Directors reserves the right to seek clarification for costs incurred and may request additional information from the recipient. Successful recipients are required to be a reviewer for NBVLL grants and fellowship applications in the calendar year following completion of their grant or fellowship.</p><p>CHECKLIST FOR COMPLETION OF APPLICATION</p><p>Before submitting your application, please ensure that you have:</p><p>Completed all relevant sections of the application form</p><p>Included evidence that you meet the eligibility criteria. This may include a current practicing certificate or proof of employment. </p><p>Included original signatures from all chief investigators and certifying parties</p><p>Read and understood terms and conditions of the NBVLL grants and fellowships</p><p>Nurses Board of Victoria Legacy Limited Grants and Fellowships 14 Application Form 2018 Nurses Board of Victoria Legacy Limited Grants and Fellowships 15 Application Form 2018</p>