Research Grant Application Form - 2022 (New) - Waikato Medical Research Foundation

Your application should reach the WMRF Administrator by Thursday 31 October 2022.

One signed original is required.

Please post or deliver to:

WMRF Administrator, c/o Waikato Clinical Campus, Peter Rothwell Academic Centre, Waikato Hospital, Pembroke St, Private Bag 3200, Hamilton 3240.

* If you have previously received a research grant from WMRF, please ensure you have supplied an interim or final report prior to submitting a new application.

1. Chief Applicant’s Contact Details

Full name

Iwi (if applicable)

Title/Position

Name of institution at which carried out

Address of institution

Postal address of applicant

Phone and fax numbers

Ethnicity

2. Project Summary

Title

Abstract (500 words max.)

Media Summary of Research or Project (200 words maximum)

Explain the research project, and its significance to health, in language understandable to the public as a press release.

Outcome Statement

Explain what utility or benefits the research may have (e.g. leading to a treatment, diagnosis, product or service, not papers and abstracts etc - these are outputs).

3. Funding Sought

Total cost of project:

Other sources of funding:

Amount applied for

4. Bank account details for transfer of funds

Account number

5. Co-applicants

How many co-applicants are there?

First Co-applicant

Full name

Department

Position

Organisation

PO Box / Street Address

Suburb

City and Postcode

Phone

Project Role

Second Co-applicant

Full name

Department

PO Box / Street Address

Suburb

City and Postcode

Phone

Project Role

Section A: Proposed Investigation

Nature and Purpose of Project

Provide sufficient detail for the Foundation’s Grants Committee to understand the nature and purpose of the investigation.

Background and Significance of the Project

Provide a brief review of relevant published or completed research to show the significance of the project and how it relates to previous or ongoing work by the investigators. Minimise the use of abbreviations and provide an abbreviation key if abbreviations are used. As appropriate, include relevance or impact of current issue for Māori.

Specific Aims of the Project

State the principal research questions/hypotheses and aims/objectives.

Research Design and Methods

Describe the main methods to be used to achieve the aims of the project. Include information on goals and strategies for participation of Māori in this project. Outline specific measures that will be undertaken to strengthen health advancement for Māori participants or Māori communities.

Statistical Analysis Plan

Describe the analysis plan for the project in sufficient detail that the Grants Committee can assess the appropriateness of the intended analyses and statistical methods. Sample size calculations should be included where relevant to demonstrate the adequacy of subject numbers.

Research Impact

Describe the potential impact of the project on health outcomes, healthcare delivery and workforce development. Outline specific benefits to the Waikato region. Include information on potential advancement of Māori health, or improvements in equity that are expected from the project.

Proposed Publication or Dissemination of Project's Results

Describe how you plan to disseminate the results.

Proposed Timetable

State the estimated start and completion dates of the project and its components.

Section B: Support for the Project

Institutional support available (provide details under the following headings)

(a) Location

(b) Funding from other sources

Note: Applicants should ensure that they have the support of their institution and that the necessary space, facilities, insurance cover, maintenance, services and technical assistance are available. Confirmation of this by the Head of Department in the relevant Institution guaranteeing these requirements is required, either in Section E or as a separate letter attached to the application.

Referee Reports

Ensure that the Foundation receives a minimum of two confidential referees’ reports from scientists or clinicians that can provide an independent and unbiased assessment of the project.

Referees from the same department will not be considered. Referees with a close working relationship, recent co-publication or collaboration would be considered biased and may result in a reduced score.

In addition, the committee may seek additional evaluations from independent reviewers that it chooses. Please advise names of any potential reviewers that the applicant believes, for whatever reason, may not give fair reviews.

Referees should be asked to comment on the following aspects of the proposal:

Relationship with applicant and the referee’s ability to give an independent unbiased report
Prior research performance and competence of the applicant(s)
Intrinsic merit of the proposed research
Its relevance to medicine and health, particularly in the Waikato region
The likelihood the researcher(s) will achieve their stated aims.
It is the responsibility of the Applicant to ensure that referees’ reports are sent directly to the Foundation (either by post or e-mail) and are received by the closing date (5PM, Monday, 31st October 2022)

Please state the full names, positions & contact details (including email address) of your proposed referees.

Ethical Approval

All successful applications involving human and animal subjects must seek Ethical Approval. This approval is not required on application, but is required to complete grant funding requirements. Ethics Approval must be obtained within six months of the grant being awarded, after which time the grant may be withdrawn.

A copy of this approval should be forwarded to the administrator to complete the Grant requirements prior to funds being released. For human subjects, online HEDC applications are made at https://ethics.health.govt.nz (link opens in a new window)

Section C: Detailed Budget

Provide a detailed budget with full supporting documentation, calculations and the period of expenditure. Grant support is usually limited to 12 months, but a longer period (up to 2 years maximum) may be granted at the discretion of the Trustees if clearly justified below. Suggested headings are given below, but some categories may not be relevant to your project. Lack of justification will result in a reduced overall score. If you are only applying for part-funding from WMRF, clearly identify what is being paid by other sources.

Project personnel

Equipment / assets* and related expenses

Equipment cost quotation

Max. file size: 24 MB.

Consumables

Travel / accommodation & field expenses (not conference)

Computing / data management / statistical assistance

Library Services

Other services (for example, attending a workshop, photography, word processing)

Publication costs (including publishing charges, photography, printing, etc)

Communication costs (postage, telephone, etc)

Total Expenses

Note: the Foundation does not support major capital items, including equipment, exceeding $5,000.

Budget Justification

Section D: Research Backgrounds & Curriculum Vitae of Principal Applicant and Participating Staff

Please use the New Zealand MSI standard Curriculum Vitae Template. All of Part 1 and Part 2a should be completed. The total CV should not exceed 5 pages (2 pages for Part 1 and 3 pages for Part 2a).

Download the template. Once completed, please upload it below.

Upload Completed CV:

Drop files here or

Max. file size: 24 MB, Max. files: 10.

Section E: Certification

Certification that the Director/Head of Department or relevant controlling officer, has agreed that the work may be undertaken in the applicant's institution.

Download the certification template. Once completed, please upload it below.

Upload Completed Certification:

Drop files here or

Max. file size: 24 MB, Max. files: 10.