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This is a template to assist with completing the form. It cannot be submitted as a Word document as the application must be submitted online. The content can be copied onto the online form however.

Evaluation, Trials and Studies Coordinating Centre

NETSCC Application Support Form for OUTLINE applications only

OUTLINE APPLICATION - RESEARCH DETAILS

Main FormProgramme Defaults to the programme you are applying for

Funding Opportunity Defaults to the stream of funding you are applying for

Call Defaults to the call you are applying for

Application InformationHost OrganisationThe host organisation must be selected from our current list – you will need to contact the funding team if your organisation is not listed.Research TitleYour full project title(Limit 300 characters)

Research TypePrimary/Secondary/Evidence SynthesisProposed start date, duration (in months) (end date is calculated from start & duration for you)Start date must be in the future and on the first of the month.How did you hear about this call?Select from drop down list or ‘other’ with description(Limit 100 characters)Total research costs requested (not including NHS support & treatment costs)Requested research fundingTotal NHS support & treatment costsProposed treatment costs could be savingsI have read the NIHR Carbon Reduction GuidelinesThese can be found at http://www.nihr.ac.uk/files/NIHR_Carbon_Reduction_Guidelines.pdf This is mandatory to confirm you have read the carbon reduction guidelines.

Tick box

NETSCC Outline Application - This is not a valid Application form

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http://www.nihr.ac.uk/files/NIHR_Carbon_Reduction_Guidelines.pdf

http://www.nihr.ac.uk/files/NIHR_Carbon_Reduction_Guidelines.pdf




CONTACT INFORMATION

Details of Chief InvestigatorTitleFirst NameMiddle Name (optional)Last NameSpecialityOrganisation (Affiliated Organisation form)You can select or add Affiliated Organisations as required. One must be your Primary organisationAdd or Edit Organisation AffiliationYour organisation, job position and department.Identify whether this is your Primary organisation and state your type of affiliation e.g. Employee or Board Member (select from a drop down list of values)


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LEAD APPLICANT DETAILS

Lead Applicant DetailsSpecify Role in research(Limit 200 characters)% FTE commitmentYour proposed percentage of full time commitment to the researchDo you currently hold an NIHR award? Yes/No selectionIf yes please specify(Limit 100 characters)Date of commencementdd/MM/yyyyIs this a full time post? Yes/No selectionIf no, please give wte% (whole time equivalent)Percentage of your work covered by this awardCurrent gradeYour current staff gradeCurrent Research CommitmentsSummarise any current research commitments(Limit 200 characters)

Lead Applicant Information – Please provide an approximate breakdown of how your current appointment is divided between the following activities:

Service/Clinical % Research % Teaching % Other %

Please specify the other research activity(Limit 100 characters)

Do you require or currently hold a working permit or visa? Yes/No selectionIf yes, please give details(Limit 200 characters)

Are you on a fixed term contract? Yes/No selectionIf yes, please give details(Limit 200 characters)

When does the contract expire?dd/MM/yyyyWill you require an honorary contract to complete this work? Yes/No selection

Administrative Contact Details


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NETSCC Application Support Form for OUTLINE applications onlyDo you wish us to contact you, the lead applicant, regarding this application? Yes/No selection

If no, provide administrative contact details (name, post held, department, organisation, contact details and access rights)Edit Contact to enter detailsOn the Research Team page you will need to click Notify against this person so they can agree to participate and be sent login details


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CURRICULUM VITAE

Degrees and Professional QualificationsAdd or Edit Degree or Professional QualificationList your higher and professional qualifications. (Include subject, awarding body, class and date are mandatory items).You will be asked to add these separately on the electronic form. Entries entered on previous applications will be shown as these are stored against the applicant.

Present and Previous Positions HeldAdd or Update Present & Previous Employment Held currently or in the last 5 yearsPlease see funding programme guidance for suggested job history requirements. You will be asked to add these separately on the electronic form. Entries entered on previous applications will be shownas these are stored against the applicant.

Job title and Employing Organisation Period of employment (From/To)If this is a current post you will only need to enter a start date.

Patient / Service User or Carer ApplicantsAre you (Lead Applicant) a patient/service user or carer?You must respond to this question,

Yes/No selection

If yes, please tell us about your knowledge, skills and experience that are relevant to this application. You are not required to provide a CV. Please read the guidance provided on information to include.Only complete if lead applicant is a patient/service user or carer

(Limit 1000 characters)


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RESEARCH CV

Recent Relevant PublicationsPlease provide a MAXIMUM of 6 of your most recent publications relevant to this application (using Vancouver or Harvard citation format) listed one after another with a blank line between each one. Please note if you choose to ‘view all publications held’ this will only show publications you have previously notified us about but you can copy and paste any publications relevant to this application from this list.(overall limit 10,000 characters)

Research Grants HeldThis should include research grants held (as a named applicant) CURRENTLY or IN THE LAST 3 YEARS – please include who the grant is with and the amount of each grant. If no grants are held please enter N/A (as this is a mandatory field). Please note if you choose to ‘view all grants held’ this will only show research grants you have previously notified us about but you can copy and paste any grants from this list.Add a list of research grants in the text box with a blank line between each one.Required information: Title, Source, Role in this research grant, Funding Period, Amount of Grant(overall limit 10,000 characters)


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CO-APPLICANTS

Co-ApplicantsWill you be using co-applicants in your proposal? Yes/No selection

Name, Organisation, Department, Post Held, Email address. Add your co-applicants for this proposal in this form. You will need their email address (preferably

their organisation one). If you have added a co-applicant in error or made a mistake with the email contact, you should delete this contact and add as a new contact. You will not be able to ‘amend’ this information on their record.


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PATIENT AND PUBLIC INVOLVEMENT (PPI)

Were patients and the public actively involved in identifying the research topic or prioritising the research questions?

Yes/No selection

Were patients and the public actively involved in preparing this application? Yes/No selection

If yes to either or both of these questions, please give details. Describe how patient and public involvement has informed and/or influenced the development of the application and how patients and the public have been involved.(Limit 1200 Characters)

If no to either or both of the previous questions, please explain why patient and public involvement was not necessary.(Limit 1200 Characters)

Planned patient/public active involvement in proposed researchPlease indicate the ways in which patients and the public will be actively involved in the proposed research. Tick all relevant boxes.This is a selection list and you should select as many of the check boxes as are relevant. Depending on the responses you should complete the additional questions in the following two boxes.☐ Design of the research☐ Management of the research (eg steering/advisory group)☐ Developing participant information resources☐ Undertaking/analysing the research (e.g. member of research team)☐ Contributing to the reporting of the research☐ Dissemination of research findings☐ Other☐ No plans for involvement

If active involvement is planned, please give more details, including how it will benefit the research, the reasons for taking this approach and arrangements for training and support.You will need to complete this if you have selected any items in the list. (Limit 1200 Characters)

If there are no plans for active involvement, please explain why it is not thought necessary.You will need to complete if you have not selected any of the items in the previous list. (Limit 1200 Characters)


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HISTORY OF APPLICATION

Previous SubmissionHas this application, or a similar application previously been submitted to this or any other funding body? Yes/No selection

Application(s) Submitted to NETS programmes (since 1 April 2012)Any previous applications that you have submitted to NETS programmes since 1 Apr 2012 will be listed in this section. You have the opportunity to identify if they are relevant (yes/no) to this current application and to Edit information as described in the two questions below.Other Funders / Applications in ProgressYou can Add any applications in progress submitted to other funders in this section using the add facility.Required informationProject Title: (Limit 300 characters)Funding Body: (Limit 100 characters)Funding Scheme: (Limit 100 characters)Application Reference Number: (Limit 30 characters)Application Type: Select from Expression of Interest, Outline, Full or OtherOutcome: Select from Pending Decision, Funded, Not Funded, Provisionally Funded, Funded with RevisionsDate of Outcome: dd/MM/yyyy

Description of FundingPlease indicate how your current research proposal differs from this previous applicationRequired information(Limit 1500 characters)

If unsuccessful, please indicate whyRequired information(Limit 1500 characters)

APPLICANT’S INFORMATION


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CASE FOR SUPPORT

Title and AbstractScientific AbstractSee funding opportunity guidance(Limit 3500 characters)

Summary (in plain English)See funding opportunity guidance(Limit 3500 characters)


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RESEARCH PLAN The list below is the full list of questions that could be asked in this section. Each call may have a different subset of these questions so please check Guidance Notes or the online version before answering these questions. On the screen, you access the response section by clicking on the ‘add’ button. Please note if the response is required (yes under the ‘Required' column in this section) you will need to complete the response. View the Research Plan page of the online form to see the questions that are relevant to the call to which you are applying. You should enter N/A if you do not have any comments to make

See the funding opportunity guidance when answering any of these questions.

Question ResponseAddress Feedback from First StageProvide feedback from the first stage of the application process that you have taken into account in this proposal (if this is the first application please enter N/A if an answer is “required” for this question)(Limit 1500 characters)Additional AlterationsProvide details of any further alterations you have made since the first stage of the application process (if this is the first application please enter N/A if an answer is “required” for this question.)(Limit 2500 characters)MeSH TermsPlease provide any MeSH terms that relate to this proposal.(Limit 1500 characters)DesignPlease provide a plan for the research design.You may wish or be asked to upload supporting documents to accompany this response.(Limit 4000 characters)Design – EME (EME calls only)Please provide a brief description of the project profile.You may wish or be asked to upload supporting documents to accompany this response.(Limit 8000 characters)


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NETSCC Application Support Form for OUTLINE applications onlyQuestion ResponseSettingPlease provide a research plan for the setting.You may wish or be asked to upload supporting documents to accompany this response.(Limit 1500 characters)Target Population(Limit 1500 characters)Inclusion/exclusion criteria(Limit 2500 characters)Health TechnologyPlease provide details of the Health Technology being assessed.(Limit 2500 characters)Control TreatmentPlease provide details of the control treatment.(Limit 2500 characters)Planned InterventionsPlease provide details of the Planned interventions.You may wish or be asked to upload supporting documents to accompany this response.(Limit 2500 characters)Who will deliver the intervention(s)?(Limit 1500 characters)Proposed Outcome Measures(Limit 2500 characters)Search Strategy(Limit 2500 characters)Review Strategy(Limit 2500 characters)Assessment and Follow Up(Limit 2500 characters)Sample Size(Limit 2500 characters)Statistical Analysis(Limit 2500 characters)Care Pathways in comparative or randomised trials(Limit 2000 characters)Differences between current


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NETSCC Application Support Form for OUTLINE applications onlyQuestion Responsestandard care pathway and planned(Limit 1500 characters)Network SupportPlease identify any Clinical Research Networks your project is associated with and provide a brief summary of their support(Limit 2500 characters)Programme RemitExplain how the proposed research is within the programme remit, and for commissioned calls, how the proposed research is within the commissioning brief(Limit 3500 characters)Mechanistic StudiesPlease provide details of any mechanistic components of your study(Limit 1500 characters)


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BACKGROUND AND RATIONALE

What is the problem being addressed?See funding opportunity guidance(Limit 2000 characters)

Why is the research important in terms of improving the health of the public and/or to patients and the NHS?See funding opportunity guidance particularly for responses in this section(Limit 3500 characters)

Please provide evidence explaining why this research is needed now (how does the existing literature support this proposal)?See funding opportunity guidance(Limit 2000 characters)

Aims and ObjectivesSee funding opportunity guidance(Limit 3000 characters)


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CHANGES FROM FIRST STAGEChanges from the first stage1/Outline StageHow has this changed from the first stage application?See funding opportunity guidance. Only complete if there has been a previous stage to this application otherwise enter N/A in this response.(Limit 3500 characters)


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DISSEMINATION AND OUTPUT

Please describe your plans for disseminating the findings of this research.See funding opportunity guidance.(Limit 2500 characters)

Expected Output of Research/ImpactSee funding opportunity guidance.(Limit 2500 characters)


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RELEVANT EXPERTISE

Strengths of Research Team – contribution of each memberSee funding opportunity guidanceIf known, you should identify your planned co-applicants and their institutions, the role they will take and the strengths of individuals to the team.(Limit 2000 characters)

Please declare any conflicts or potential conflicts of interest that you or your co-applicants may have in undertaking this research, including any relevant, non-personal & commercial interest that could be perceived as a conflict of interest.See funding opportunity guidance. (Limit 2000 characters)


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JUSTIFICATION OF COSTS

Please explain how the research provides value for money.See funding opportunity guidance. (Limit 2500 characters)

Please explain how the research costs requested have been calculated and justify how they have been allocated.See funding opportunity guidance. (Limit 2500 characters)

Please explain how the NHS Support and Treatment costs requested have been calculated and justify how they have been allocated.See funding opportunity guidance. (Limit 2500 characters)


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INTELLECTUAL PROPERTY (IP)

What relevant IP (patents, design right, copyright etc.) is held by the applicants and how does it relate to this application?See funding opportunity guidance(Limit 3000 characters)

Has a freedom to operate search been conducted? Yes/No selection

If yes, please provide details of all relevant IP and how it relates to the application and details of who carried out the freedom to operate searchSee funding opportunity guidance(Limit 1500 characters)

If no search has been conducted, please set out the rationaleSee funding opportunity guidance(Limit 1500 characters)

Will any IP be produced or improved during the proposed research? Yes/No selection

If yes, please describe what IPR will be produced or improved.See funding opportunity guidance(Limit 3000 characters)

Please describe how any new IP generated through the proposed research will be recognised, captured, managed and utilised, either through dissemination and adoption in the healthcare service or through commercial exploitation. Please give details on who will lead on dissemination and/or exploitation.See funding opportunity guidance(Limit 3000 characters)

What are the key current and future barriers to utilising the IP/innovation through adoption in the healthcare service or through commercial exploitation, e.g. potential regulatory hurdles? See funding opportunity guidance(Limit 3000 characters)


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WIDER CONTEXT

In your proposed research, do you intend to link to NIHR Networks? If yes, please state which networks.See funding opportunity guidance(Limit 400 characters)

Please describe the benefits identified from working with networks.See funding opportunity guidance(Limit 1500 characters)

Please indicate other organisations (i.e. Research Design Services) that you may have contacted in the course of preparing this application.See funding opportunity guidance(Limit 1000 characters)

Clinical Trials Unit’s (CTU) Participation

Is a Clinical Trials Unit involved with this research proposal? Yes/No selection

Clinical Trials Units InformationYou can Add one or more Clinical Trials Unit.

Required Information:Clinical Trials Unit Name:Registration Number if provided:Is the CTU receiving CTU support funding from NIHR?

If applicable, please describe how you have worked with a Clinical Trials Unit in developing your application and what support they will provide if funding is approvedSee funding opportunity guidance (this may not be relevant to you application).(Limit 1500 characters)


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NETSCC Application Support Form for OUTLINE applications onlyIf a Clinical Trials Unit is not being used, please explain why and who/what will be involved instead, if applicable to this application.See funding opportunity guidance(Limit 1500 characters)

What if any, other NIHR organisations will partner this research?Selection from a dropdown list which includes ‘none’

Describe the role, if any these will have in the researchSee funding opportunity guidance(Limit 1500 characters)

Other sources of fundingWill this application be supported by any other funding body? Yes/No selection

Other Sources of fundingYou have the opportunity to Add this information

Required InformationSupporting organisation: (Limit 100 characters)Detail any proposed arrangements for shared funding: (Limit 2000 characters)Funding Amount:Start date:End date:


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DH MONITORING

A.1 Your Research ProposalLead Applicant’s Place of WorkLead applicant’s professionSelection from dropdown list

Is the research multi-centre? Yes/No Selection

Research regionSelection from dropdown list

A.2 UKCRC Health Categories UKCRC Health CategoriesSelect all that apply to the research. See information at http://www.hrcsonline.net/hc/overview

A.3 UKCRC Research Activity CodesHealth Research Activity TypeSelect any that apply to the researchSee HRCS Research Activity Codes information at http://www.hrcsonline.net/rac/overview


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http://www.hrcsonline.net/rac/overview

http://www.hrcsonline.net/hc/overview




RDS INVOLVEMENT

Did you contact a the Research Design Service (RDS) ? Yes/No Selection

If so, please indicate the RegionSelection from dropdown listIf not was it because:Check box selection with opportunity to add other☐ Team has sufficient Methodological Expertise☐ Unaware of RDS Support☐ Other

Other (please specify)Must be completed if “Other” selected above(Limit 100 characters)Measure of satisfaction with the RDS input Selection from dropdown list:Very SatisfiedSatisfiedDissatisfiedVery Dissatisfied

To what extent do you feel the quality of your proposal improved as a result of RDS involvement?(Limit 1000 characters)

Would you recommend the RDS to other people developing research proposals? Yes/No Selection

Please expand on your responses above, explaining the reasons for your choices, and including details about the extent and nature of the support provided by the RDS. Please also add any other comments about your experience of using the RDS.(Limit 1000 characters)


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SUGGESTED REFEREES

Reviewers suggested by applicant You can suggest up to three reviewers (referees) and also indicate, optionally, up to two reviewers who we should not approach.

Reason for suggesting this person(Limit 500 characters)

Person detailsNamePost HeldSpecialty

Contact detailsDepartmentInstitutionAddress1Address2Address3CountyPost CodeEmail AddressPhone Number

Reviewers not recommended by applicant

Reason for not suggesting this person(Limit 500 characters)

Person detailsNamePost HeldSpecialty

Contact detailsDepartmentInstitutionAddress1Address2Address3CountyPost CodeEmail AddressPhone Number


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UPLOADS

Upload ChecklistSee funding opportunity guidance. You will find a list of uploads that should accompany your application at this stage. You must, at least, upload any document that has a Yes in the Required column and also any other document requested in the guidance notes for this funding opportunity. Select the type and select upload on the form. Further instructions on how to complete the upload are provided on screen as well as type of documents. Uploads in support of applications are limited to 2Mb per document uploaded.

ACKNOWLEDGEMENT

Agreement to the Terms and ConditionsAcceptance Statement is: ’I have read and understood the terms on which I have been nominated as Chief Investigator for this proposal along with the associated documentation and accept this role.’

A link to terms and conditions is provided on the MIS when you register (see http://www.netscc.ac.uk/MIS/terms.asp). For further information about research roles please see funding programme guidance.


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http://www.netscc.ac.uk/MIS/terms.asp

· web view evaluation, trials and studies coordinating centre. evaluation, trials and studies...

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