research grants 2010 - the Asthma Foundation by zhouwenjuan

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									    Asthma Foundation NSW
    research program grants 2011



grant application form innovation grants
Please complete ALL the following information


1. Read the Conditions associated with Asthma Foundation NSW New Investigator Grant before completing
   this form.

2. The completed form must be forwarded and received electronically by the
   Administrative Officer of the Institution or University to research@asthmafoundation.org.au
   by 5.00pm Friday 6th August 2010.

   Subject heading in the email must be: Application: Asthma Foundation NSW Innovation Grant 2011

3. One original copy must be mailed direct to Asthma Foundation NSW:

   Research Program Manager
   Asthma Foundation NSW
   Level 3, 486 Pacific Highway
   ST LEONARDS NSW 2065



Late or incomplete forms will not be accepted.

Please complete the application within the set margins using single spaced 11-point Arial font
throughout.

Any content exceeding the stated limits will not be considered in the assessment of the application.

Applications must be received by 5.00pm on Friday 6th August 2010 for support commencing
January 2011




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     Asthma Foundation NSW
     research program grants 2011



grant application form innovation grants
Closing date: Applications must be received by 5.00pm Friday 6th August 2010

1.   Research Project Title




2.   Description of Project
     (Suitable for lay audience and to be used for publicising the activity (max ½ A4 page, 11-point Arial font, single
     spaced, maintain set margins )




3.   Applicant Name(s)
     Please name the Chief Investigator(s):

     Investigator: …………………………………………………………………………………………………………………….




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     Asthma Foundation NSW
     research program grants 2011



Asthma Foundation NSW are in receipt of monies from an external trust as detailed below, to be directed to
the support of specific types of research. This trust is in addition to internal funding from AFNSW sources and
application for funding from this trust in no way excludes or influences consideration in the AFNSW annual
research program.

Ross Trust: ‘The Ross trust is a charitable trust established for purposes including support and endowment of
medical and scientific research in NSW with emphasis on research directed at the improvement of the health
and elimination or reduction of the incidence of disorders and diseases affecting infants and children.’

This benefactor is under no obligation or commitment to fund any grants.

If you wish your grant to be reviewed for consideration for funding by any of this group please indicate by
ticking the box below.

 I wish to be considered for funding from the Ross Trust

4.   Details of relevance to external trust aims
     (Indicate how your proposed research project meets the funding criteria as described above)
     (max ½ A4 page, 11-point Arial font, single spaced)




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     Asthma Foundation NSW
     research program grants 2011



Applicant(s) details
Please provide ALL details for the Chief Investigator, and each other Applicant. Copy extra tables if required.

Chief Investigator
Full Name
Position
Organisation
Postal Address
Phone (wk)
Mobile
Email
Year of Birth
Current Appointment
Academic Qualifications
(indicating institutions and dates)
Time to be devoted to this project
Time to be devoted to other projects

Applicant 2
Full Name
Position
Organisation
Postal Address
Phone (wk)
Mobile
Email



5.      Where will proposed project be based?

Name of Institution
Department
Postal Address



6.      Projected duration of project
        Please estimate the projected duration of the Grant. Grants that are commenced and completed within a 12-month period (the
        year of the grant) are preferred. Other high interest, high quality Grants of longer duration may be considered.




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     Asthma Foundation NSW
     research program grants 2011




7.    Other Funding Sources
      Have you applied or do you intend to apply to another grant source for this project?
       Yes  No
      If yes, which other grant source?


      When will the results of the other applications be known?


8.    Other Associate Investigators
      Other than those listed in item 1 above, who else will be working on the proposed project? Please provide ALL
      details for each applicant and copy extra tables if required.

Associate Investigator 1
Full Name
Position
Organisation
Academic Qualifications
What role will they play?



9.    Ethics Approval(s)
      Have all relevant ethics approvals been obtained or been sought?
       Yes  No
      Please provide details:




      (Note: Ethics approvals will be required before final grant approval can be made).


10. Previous Grants from Asthma Foundation NSW
      If you have received Asthma Foundation NSW Research Grant/s within the last five years, please provide details:




11. Additional Research
      Please indicate that all applicants are not currently in receipt of, or plan to seek or accept any form of funding from any
      person or organisation having an association or interest in the manufacture or marketing of cigarettes, tobacco
      products, or other areas of work known to be harmful to people with asthma.
       True  Not true



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   Asthma Foundation NSW
   research program grants 2011



12. Aims and relevant hypotheses and relevance to asthma
    (max one A4 page Arial 11-point font , single spaced, maintain set margins)




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   Asthma Foundation NSW
   research program grants 2011



13. Background information/Forerunner studies
    (max two A4 pages, Arial 11-point font, single spaced, maintain set margins)




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   Asthma Foundation NSW
   research program grants 2011



14. Research plan and methods
    (max three A4 pages, Arial 11-point font, single spaced, maintain set margins)




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    Asthma Foundation NSW
    research program grants 2011



15. References
        Please list references relating to this project.
        1.
        2.
        3.


16. Previous project grants
        List all grants received from all sources in the last six years.




17. Publications of Chief Investigators
        Please list publications in last five years; do not include abstracts. Provide a separate list for each Chief Investigator
        and copy extra tables if required.

Chief Investigator
Full Name
Publications



18. Recommendations for non-NSW assessors
        Applicants are requested to provide names and addresses of people outside New South Wales who may be
        qualified as independent assessors. The applicant(s) must not have undertaken research or other collaboration
        with the named independent assessor(s) within the last three (3) years. There is no undertaking that nominated
        persons will be asked for comment.
        Please provide ALL details for each potential assessor and copy extra tables if required.

Assessor
Full Name
Position
Organisation
Postal Address
Phone (wk)
Mobile
Email

Assessor
Full Name
Position
Organisation
Postal Address
Phone (wk)
Mobile
Email
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    Asthma Foundation NSW
    research program grants 2011



Applicants may also submit names of assessors they would prefer do not assess their application. There is no
undertaking that nominated persons will not be asked for comment. Please provide ALL details for each non-preferred
assessor and copy extra tables if required.

Non-Assessor
Full Name
Position
Organisation
Postal Address
Phone (wk)
Mobile
Email



19. Budget Explanation
        One page only, please:
        a) Detail personnel required
        b) Detail equipment to be acquired and source
        c) Detail maintenance items

Categories                         Note No      Cost for Year 2011         Comments
Personnel – please list               (1)                                  Total salary paid for 2011
- Individual A
- Individual B
Equipment (list if >$5,000)            (2)
Admin, eg data processing              (3)
Consumables/miscellaneous              (4)
TOTAL GRANT                                                      $
If applicable
Travel allowance                       (5)                       $500      Inclusive of GST

        Notes to Budget:

        Note (1) – Please detail all staff included in this project and ensure all salaries are reported in accordance with the
        practice of the host Institution. Include all on costs associated with the positions in the total cost.

        Note (2) – For any item of equipment required to be purchased please provide full details via copy of final invoice
        for any item in excess of $5,000.

        Note (3) – Please detail an amount deemed necessary for the provision of administration expenses, eg cost of data
        processing that wish to be claimed under the grant.

        Note (4) – Please detail an amount deemed necessary by way of consumables to be claimed under the grant.

        Note (5) – If the recipient is successful in receipt of $500 towards travel in line with the conditions, full
        documentation of usage is required to be provided with the final report.

        Asthma Foundation NSW reserves the right to question or reduce any component of the above budget that it
        deems unreasonable.




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   Asthma Foundation NSW
   research program grants 2011



20. Declarations
     a) Declaration by Investigators

     By signing this application, all investigators involved in the research project that is the subject of this application,
     individually and collectively, confirm and declare that the information provided in this application is true and accurate in
     every respect.

     Signature of Applicant/s (all to sign)

     Signature …………………………………………………………                                         Date …………………………………

     Signature …………………………………………………………                                         Date …………………………………

     Signature …………………………………………………………                                         Date …………………………………

     Signature …………………………………………………………                                         Date …………………………………

     b) Declaration by Heads of Department

     I, ………………………………………………… (print or type name) hereby certify that …………………………….……….
     (print or type grant name) is appropriate to the general facilities in my Department and that I am prepared to have the
     grant carried out in my Department.

     Name (print or type name)……………………………………………………………………………………………….....

     Signature (Head of Institution or Nominee) ………………………………………… Date ……………………………

     c) Declaration by Head of Institution

     I, …………………………………………………. (print or type name) hereby certify that ……………………………………
     (print or type grant name) is acceptable to the Institution and that the salaries quoted for personnel are in accordance
     with practice at this Institution. I certify that the Institution is prepared to undertake financial administration of the
     project.

     Name (print or type name)……………………………………………………………………………………………….....

     Signature (Head of Department) …………………………………………………….. Date ……………………………




 Asthma Foundation NSW Privacy Statement
 The Asthma Foundation of NSW (‘The Foundation’) is committed to abiding by the National Privacy
 Principles as set out in the Privacy Act 1988 and the Privacy Amendment (Private Sector) Act 2000.

 The information requested is required by the Foundation to fully assess all applications.

 The Foundation undertakes to maintain the confidentiality of all details held and will not disclose those
 details to any third party except when authorised by the individual concerned or required to do so by law.




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