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HEALTH RESEARCH

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					                             LOTTERY

                             HEALTH RESEARCH
                             Research Project and Shared Equipment
                             Te Tahua Rangahau Hauora
                             Referee Report                                                              NZ Lottery Grants Board
                                                                                                                 TE PUNA TAHUA
                                                                                                        Distributor of NZ Lottery Profits




O F F I C E U S E O N LY:
Application Agenda No:


          A P P L I C A N T S D E TA I L S (Principal researcher to complete first two boxes and forward to the referee
          with a copy of the application)
                 Name(s) of Researcher(s)
                First name                                              Last name


                First name                                              Last name


                First name                                              Last name




                 Short title of research




                 Referee’s comments (Refer to notes on the last page)




                                                                                    Please continue on separate sheet if necessary
 PAGE 1
                                                                                                                               NOVEMBER 2005
         R E F E R E E D E TA I L S

               First name                                               Last name


               Position


               Daytime phone number                                     Alternative phone number
                 (       )                                                 (        )

               Fax number                                               Email address
                 (      )

               Address


               City/town


               Signature                                                Date
                                                                                                    (day / month / year)



                This report will be released to the applicants, if requested, with your name deleted.
                Please advise here if you are not willing for the report to be released.

                          YES

                          NO




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         G U I D E L I N E S F O R R E F E R E E S F O R A P P L I C AT I O N S F O R R E S E A R C H P R O J E C T S
         AND SHARED EQUIPMENT
         Note : referees for PhD Scholarship applications should refer to the separate form designated for this
         purpose, as the requirements for these referee reports are different.

               Lottery Health Research is one of the Lottery distribution committees. It provides funding for non-profit-making
               good quality basic and applied research relating especially to common human health problems considered to be
               of major significance to the New Zealand community. It is also interested in research into the prevention and
               management of the common problems and disorders which lead to deterioration of normal health.

               Lottery funding is one of the very few sources of discretionary funding available to the community. Lottery profits
               are not government funds and are not intended to fund services for which government agencies are responsible.

               As a referee, you play an important part in the Committee’s grant allocation process. Your report will assist the
               Committee to assess the merits of the application and to determine its priority for funding, and can provide useful
               feedback to the applicants.

               Please provide a brief scientific report on the application. This should include comment on the quality of the
               research, how achievable the objectives are, the planning of the project, the track record of the researchers, the
               likely take up of results, the need for the project and its likely contribution to health research overall.

               Your report may be either hand-written or typed on this form and posted to:
                             The Committee Coordinator
                             Lottery Health Research
                             Department of Internal Affairs
                             PO Box 805
                             Wellington
                             NEW ZEALAND

               Please ensure that your report is received by 1 November, in time for consideration at the Committee’s November
               meeting.

               Please send your report once only. Receipt of your report will be acknowledged. If at all possible please avoid
               faxing it, as faxed reports are often difficult to read and photocopy.

               The Lottery Grants Board is subject to the Official Information Act and the Privacy Act. Lottery Grants will make
               every effort to comply with your wishes about confidentiality subject to the provisions of these Acts. Lottery Grants
               cannot give an absolute guarantee of confidentiality especially if any person seeking information asks for a review
               by the Ombudsman or Privacy Commissioner.

               For further information contact the Committee Coordinator, Lottery Health Research, at the address above, phone
               0800-824-824 (within New Zealand), or 64-4-460-2222 (from outside New Zealand), or fax 04-460-2247.




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