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Applicant name:
Administering organisation name:
Category (please choose one):
Novice Researcher Fellowship Early-Career Researcher
Fellowship Experienced Researcher Fellowship Research Implementation
Fellowship
Nursing and Midwifery Research Fellowships Round 6 - Application Form
Nursing and Midwifery Research Fellowships Round 6Application Form – Round 6Applications close 12pm midday AEST 10 July 2020
Nursing and Midwifery Research Fellowships Application Form (Round 6)Published by the State of Queensland (Queensland Health), 2020
This document is licensed under a Creative Commons Attribution 3.0 Australia licence. To view a copy of this licence, visit creativecommons.org/licenses/by/3.0/au© State of Queensland (Queensland Health) 2020You are free to copy, communicate and adapt the work, as long as you attribute the State of Queensland (Queensland Health).For more information contact:Health Innovation, Investment and Research Office, Department of Health, GPO Box 48, Brisbane QLD 4001, email [email protected], phone +61 (0) 7 3708 5089.An electronic version of this document is available at https://www.health.qld.gov.au/hiiro/html/rpu/proj_grantsDisclaimer:The content presented in this publication is distributed by the Queensland Government as an information source only. The State of Queensland makes no statements, representations or warranties about the accuracy, completeness or reliability of any information contained in this publication. The State of Queensland disclaims all responsibility and all liability (including without limitation for liability in negligence) for all expenses, losses, damages and costs
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you might incur as a result of the information being inaccurate or incomplete in any way, and for any reason reliance was placed on such information.
1 Application instructionsBefore completing this form, please ensure that you have read all relevant documentation for this Round available at: https://www.health.qld.gov.au/hiiro/html/rpu/proj_grants
1.1 Submission of ApplicationApplications are to be submitted to [email protected] by 12pm midday AEST 10 July 2020. The application should be submitted as a single, consolidated PDF file using the naming convention Surname_Firstname_NMRF application.pdf and include, in the following order:
Application Form A reference list (if required) Funding Agreement Declaration page
Late applications will not be accepted.
1.2 Formatting requirementsWhere there is no response to a question, please indicate ‘not applicable’.The application form must be submitted in its original form by the applicant organisation. Applicant organisations are not permitted to edit the underlying template of the application form (unless where indicated).
2 Applicant detailsThe proposed Fellow (Chief Investigator)
Title (Prof, Dr, Mr, Mrs, Ms etc)
Surname
First name(s)
Gender
Work phone number
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Mobile phone number
Email address (contact is via email in the first instance)
Citizenship
Primary place of residence
If not an Australian citizen, please indicate if you are a permanent or temporary resident, or hold a Special Category Visa (please provide certified copies of relevant documentation).
If not a holder of the above, has a residency permit or a Special Category Visa been sought? Please provide details.
How many full-time equivalent (FTE) years have you conducted research? (including the completion of research higher degrees)
Equal employment/diversity information – please indicate if the applicant identifies with any of the following groups.
People with a disability
Yes No
People from a non-English speaking background
Yes No
Aboriginal or Torres Strait Islander
Yes No
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Australian South Sea Islander
Yes No
3 Administering organisation detailsAdministering organisation details
Name
Organisation type (e.g. HHS, university, research institute)
ABN
Administering organisation contact details
Title Prof, Dr, Mr, Mrs, Ms etc
First name, surname
Position
Office phone number
Email address
4 Fellowship proposalProject summary
Project title (maximum 20 words)
Project description (in plain English)(maximum 100 words)
Main project location
Other project locations
Mentor details (For Novice Researcher Fellowship and Early-Career
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Fellowship applicants ONLY)
Mentor name
Mentor position and organisation/location
Phone number
Email address
Mentor academic qualifications
Mentor clinical qualifications
Mentor relationship to applicant
Mentor statement of support for the proposed fellow (maximum 200 words)
Associate InvestigatorsDetails all Associate Investigator/s. Copy and paste the table below as many times as required.
Name
Current job title
Organisation
Location
Current status of position (e.g. permanent full time/temporary full time or part time/contract FTE%)
Role in project team
Please indicate if you identify as one of the following (see Funding
Novice Researcher Early-Career Researcher
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Rules for definition)
Percentage contribution to the project
Briefly describe the benefit of the collaboration
5 Selection criteriaApplications are assessed by an expert panel, which will provide recommendations on fellowship award recipients to the Department.
5.1 Research Quality Background and Aims Outline relevant background, supported by literature review where relevant, and the specific research hypothesis. (maximum 700 words)
Methodology and ApproachDetail relevant technologies, data collection, statistical methods, justify participant numbers (e.g. power analysis). (maximum 1000 words)
Consumer involvementDescribe consumer involvement in the research project design and any ongoing consumer involvement in the research activities including any specific roles of consumer representative/s in the research project. (maximum 100 words)
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Project research milestonesList the key project research milestones and completion times. The successful Fellow will report to the Department during the duration of the Fellowship on the progress in completing the milestones.(Copy and paste rows below as many times as required)
Milestone number
Description (e.g. what will be achieved. Focus on the research project progress such as:
Participant recruitment numbers (commencement, halfway point, final)
data collection interim analysis further data collection final analysis
Please note the following are not considered as milestones:
PhD Milestones, e.g. thesis submission
gaining ethics and governance approval
preparation of grant applications advertising or recruitment of
Fellowship staff attendance at conferences publication milestones
Please use Plain English.
Completion date (e.g. Number of months from commencement)
Milestone 1
Description Due date
Milestone 2
Description Due date
Milestone 3
Description Due date
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5.2 Significance and InnovationSignificance Outline how the research will result in better patient care, improved health outcomes and/or the development of the nursing and midwifery disciplines and professions. (maximum 300 words)
InnovationDescribe the originality of the research in terms of the design, framework or method. (maximum 300 words)
5.3 Track Record Relative to OpportunityEarly Career, Experienced and Research Implementation applications - please complete the track record for the lead CI only. Novice Researcher applicants - please ensure you provide any relevant details regarding your track record first, then provide details of your Mentor’s track record.
Academic/research qualifications(Copy and paste rows below as many times as required)
Academic qualification (e.g. BSc, MSc, PhD)
Institution
Date awarded
Clinical qualifications(Copy and paste rows below as many times as required)
Professional Qualification
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(e.g. certificate etc)
Institution
Date awarded
Professional registrations(Copy and paste rows below as many times as required)
Clinical registration type (e.g. general)
Professional body and jurisdiction
Registration number
Status (e.g. current)
Current appointments and research appointment/s(Copy and paste rows below as many times as required)
Current job title
Organisation
Location
Current status of position (e.g. permanent full time/temporary full time or part time/contract).Include end date if on a temporary position. If position is not full time, include FTE%.
Publications (last 5 years)List your most significant publications from the last five years which are relevant to this proposal and after each one identify its contribution to the field. Only peer
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reviewed articles that are published or in press should be included. Do not include accepted publications (maximum 1000 words)
Key presentationsList key presentations at conference, seminars and meetings (only those relevant to this application) (maximum 500 words)
Grants awarded (last 10 years)(Copy and paste rows below as many times as required)
Title
Funder
Scheme
Year
Amount awarded
Your role (e.g. CIA, CIB etc)
Co-researchers
Project ID (if applicable)
Career disruptionA career disruption is considered to be a prolonged interruption to an applicant’s capacity to work due to pregnancy and childbirth, major illness and carer responsibilities (including parental leave). The period of career disruption may be used to determine eligibility and to allow for inclusion of additional track record information for assessment of an application by the review panel. Where relevant, applicants should nominate periods where their career has been disrupted over the last five years for a period of 90 days or more, and provide a
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brief explanation of the reason in their application. (maximum 250 words)
Time period Brief description of career disruption
Relative to opportunityOutline any significant academic, clinical responsibilities or industry work placements that impacted on your ability to conduct research over the last five years. (maximum 250 words)
Leadership and trainingDetail your involvement in research and clinical/hospital and health service leadership and training duties. This may include involvement in leadership, training and mentorship; supervision of clinical staff; supervision of research staff; relevant courses or training undertaken (maximum 250 words).
Achievements, prizes and awards for research and clinical/hospital and health service dutiesOutline any significant prizes, honours or peer-recognition you have received for research relevant to this proposal. Please include the name and brief details of the award using dot points (maximum 500 words)
Other professional activities and community involvementOutline any further significant professional activities and community involvement that is relevant to this research proposal using dot points (maximum 250 words)
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5.4 BudgetExpenditure TableOutline a budget for the requested funds for the proposed project. Please include a justification for the expenditure including how the funds will be used and why they are being requested. Only eligible project costs as outlined in the Funding Rules will be accepted.Novice Researcher and Early-Career Researchers should not complete the Year 2 column.
Expenditure Year 1
Year 2 Justification
Salaries
Equipment
Consumables
Travel (Novice Category only)
Other (including field work)
ANNUAL TOTAL
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TOTAL REQUESTED FUNDS
Income from other funding sources and expenditureThe funds provided by the Fellowship may not cover the total cost of the research. Outline any income from other funding sources and plans for expenditure including cash and in-kind contributions (maximum 300 words).
6 Certification6.1 Administering organisation certificationAs the authorised delegate of the administering organisation, I certify that all details given in this application are correct.
Applicant organisation’s certification
Authorised officer’s full name
Full name of authorised officer
Position Position
Signature
Date [DD/MM/YYYY]
6.2 Chief Investigator certificationI, the Chief Investigator, certify that all details given in this application are correct.
Chief Investigator’s certification
Title Prof, Dr, Mr, Mrs, Ms etc
Surname CI's surname
First name(s) CI's first name
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Signature
Date [DD/MM/YYYY]
6.3 Associate Investigator certificationAssociate Investigator’s certification(Copy and paste table below as many times as required)
Title Prof, Dr, Mr, Mrs, Ms etc
Surname Associate Investigator's surname
First name(s) Associate Investigator's first name
Signature
Date [DD/MM/YYYY]
6.4 Mentor certification (for Novice Researcher Fellowship and Early-Career Researcher Fellowships ONLY)
Mentor’s certificationI, agree to act as a Mentor for [insert Applicant’s name] should the Applicant be awarded a Fellowship.
Title Prof, Dr, Mr, Mrs, Ms etc
Surname Associate Investigator's surname
First name(s) Associate Investigator's first name
Signature
Date [DD/MM/YYYY]
6.5 Novice Researcher certification Novice Researcher’s certification – this certification is to be completed by Novice Researchers on Research Implementation and Experienced
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Researcher teams; and all Associate Investigators on Novice Researcher teams. I, [insert Novice Researcher’s name] confirm that I am a Novice Researcher should the applicant be awarded a Fellowship.
Title Prof, Dr, Mr, Mrs, Ms etc
Surname Associate Investigator's surname
First name(s) Associate Investigator's first name
Signature
Date [DD/MM/YYYY]
6.6 Early-Career Researcher certificationEarly-Career Researcher certification – this certification is to be completed by all Associate Investigators on Early-Career Researcher teams.I, [insert Early-Career Researcher’s name] confirm that I am an Early-Career Researcher should the applicant be awarded a Fellowship
Title Prof, Dr, Mr, Mrs, Ms etc
Surname Associate Investigator's surname
First name(s) Associate Investigator's first name
Signature
Date [DD/MM/YYYY]
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