; PART 2
Documents
Resources
Learning Center
Upload
Plans & pricing Sign in
Sign Out
Your Federal Quarterly Tax Payments are due April 15th Get Help Now >>

PART 2

VIEWS: 6 PAGES: 7

  • pg 1
									Part 2                                                                                              IN CONFIDENCE



                                                    PART 2
SECTION 1
                                                Undertakings
                           Undertakings required when submitting an application

The principal investigator, co-investigator, Head(s) of Department and appropriate administrative
authority are required to sign this form to accompany an application for a Research Grant, or
Proposal for Approval, to Cancer Research UK. Signatures must be obtained for all clinical
research, with or without funding implications.

1.1 - Principal Investigator and Co-investigators
I enclose an application for a research grant/proposal for approval, completed in accordance with the guidelines
published with the application form. I am not aware of any relevant information that has been withheld or of any
information given in the application that is misleading. I have read the attached Terms & Conditions and any
supplementary terms and conditions published with and/or referred to in the application form and, if this application is
successful, I agree to abide by them. I understand that the Terms & Conditions may change during the tenure of an
award and I would then be required to sign my agreement to the new Terms & Conditions or possibly forfeit the grant
if I cannot comply.

Name (in block capitals)                            Signature                                             Date




1.2 - Head(s) of Department
I confirm that I have read and support this application and that I am not aware of any relevant information that has
been withheld or of any information given in the application that is misleading. I agree to the research being carried
out in my department and all necessary licences and approvals have been obtained or are being sought.

Name (in block capitals)                            Signature                                             Date




1.3 - Administrative Authority
(e.g. Registrar, Vice Chancellor's Office or Secretary of Institute)
On behalf of the host institution, I confirm that the application has been submitted with the agreement of the host
institution which will administer any grant if awarded, and that it will be used only to support the work for which it was
intended or an alternative if supported by written approval from Cancer Research UK. The host institution is not
aware of any relevant information that has been withheld or of any information given in the application that is
misleading. On behalf of the host institution I confirm that I have read and the institution accepts the attached Terms
& Conditions and any supplementary terms and conditions published with and/or referred to in the application form
and that it is the intention of the institution to maintain support for this department during the period for which support
is being sought. The institution understands that the Terms & Conditions may change during the tenure of an award
and the institution would then be required to sign its agreement to the new Terms & Conditions or possibly forfeit the
grant if it cannot comply.

Name: (in block capitals)                                      Position:


Signature:                                                     Host institution:


Email:                                                         Telephone:

Date:
Part 2                                                                                          IN CONFIDENCE



SECTION 2
                                               Peer Review

Review of your application
Cancer Research UK uses national and international peer review to assist its expert Committees in assessing the
quality of research applications. It is recognised that applicants may wish to provide input into the peer review
process, but Cancer Research UK is under no obligation to take up applicants’ suggestions and will not enter into
discussion with applicants on matters relating to reviewers.

2.1 - Nominated reviewers
You are invited to nominate up to five reviewers who would be qualified to assess your application critically. You
should not nominate individuals with whom you have a close collaboration or with whom you have worked previously.
Name and current post of                       Contact details
reviewer                                       Full postal & email address and URL if possible
1.



Email:
URL:           http://
2.



Email:
URL:           http://
3.



Email:
URL:           http://
4.



Email:
URL:           http://
5.



Email:
URL:           http://

2.2 - Inappropriate reviewers
Cancer Research UK recognises that there are certain situations in which approaching a particular reviewer may not
be appropriate. Applicants may only request exclusions when there is a serious conflict of interest or commercial
sensitivity. Any requests for the exclusion of a potential reviewer must be made in writing and will not be considered
without an accompanying justification. Cancer Research UK’s decision on whether to accept or reject such requests
will be final.
Name of reviewer                      Institution                              Justification for exclusion
1.


2.
Part 2                                                                         IN CONFIDENCE



SECTION 3
                                Research Classification

If successful, details of your research proposal will be published on Cancer Research UK and
selected web-based directories of research. To enable other researchers to retrieve your
information effectively, please complete the following sections. Percentages for each of
sections 12.1 and 12.3 should add up to 100%

3.1 - Site specific cancers
Please specify the percentage of effort on relevant cancers, if possible.

Type of cancer                              %    Type of cancer                                  %

Basic Research                                   Nasal Cavity & Paranasal Sinus Cancer
Relevant to all types of cancer                  Neuroblastoma
Adrenocortical Cancer                            Non-Hodgkin’s Lymphoma
Anal Cancer                                      Oesophageal Cancer
Bladder Cancer                                   Oral Cavity and Lip Cancer
Bone Cancer                                      Ovarian Cancer
Brain Tumour                                     Pancreatic Cancer
Breast Cancer                                    Parathyroid Cancer
Cervical Cancer                                  Penile Cancer
Chordoma Cancer                                  Pharyngeal Cancer
Colon and Rectal Cancer                          Pituitary Tumour
Endometrial Cancer                               Prostate Cancer
Eye Cancer (excluding Retinoblastoma)            Retinoblastoma
Gall Bladder Cancer                              Salivary Gland Cancer
Heart Cancer                                     Sarcoma
Hodgkin’s Disease                                Skin Cancer
Kaposi’s Sarcoma                                 Small Intestine Cancer
Kidney Cancer (excluding Wilm’s Tumour)          Stomach Cancer
Laryngeal Cancer                                 Testicular Cancer
Leukaemia                                        Thymoma, Malignant
Liver Cancer                                     Thyroid Cancer
Lung Cancer (including Mesothelioma)             Vaginal Cancer
Melanoma                                         Vulvar Cancer
Myeloma (including Multiple Myeloma)             Wilm’s Tumour

3.2 - Childhood Cancer
If applicable, please specify the percentage of this project that relates to childhood cancer.

                                                %
Part 2                                                                          IN CONFIDENCE


3.3 - Type of research
Please specify the relevant percentage, if possible.
If you need further definitions of the categories of research, please refer to the Common
Scientific Outline at http://www.cancerportfolio.org/cso.jsp

Type of Research                                %   Type of Research                             %


Biology                                             Treatment

                                                          Localized Therapies - Discovery and
1.1      Normal Biology                             5.1
                                                          Development
                                                          Localized Therapies - Clinical
1.2      Alterations in Chromosomes                 5.2
                                                          Applications
         Oncogenes / Tumour Suppressor                    Systemic Therapies - Discovery and
1.3                                                 5.3
         Genes                                            Development
                                                          Systemic Therapies - Clinical
1.4      Cancer Progression and Metastasis          5.4
                                                          Applications
                                                          Combinations of Localized and
1.5      Resources and Infrastructure               5.5
                                                          Systemic Therapies
                                                          Complementary and Alternative
                                                    5.6
Aetiology                                                 Treatment Approaches
                                                          Resources and Infrastructure Related
         Exogenous Factors in the origin and        5.7
2.1                                                       to Treatment
         cause of cancer
         Endogenous Factors in the origin           Cancer Control, Survival & Outcomes Research
2.2
         and cause of cancer

         Interactions of Genes and/or Genetic       6.1   Patient Care and Survivorship Issues
2.3      Polymorphisms with Exogenous
         and/or Endogenous Factors                  6.2   Surveillance

2.4      Resources and Infrastructure               6.3   Behaviour Related to Cancer Control

                                                          Cost Analyses and Health Care
Prevention                                          6.4
                                                          Delivery
         Interventions to Prevent Cancer:           6.5   Education and Communication
3.1      Personal Behaviours that Affect
         Cancer Risk
                                                    6.6   End of Life Care
         Nutritional Science in Cancer
3.2
         Prevention
                                                          Ethics and Confidentiality in Cancer
                                                    6.7
3.3      Chemoprevention                                  Research

3.4      Vaccines                                         Complementary and Alternative
                                                    6.8   Approaches for Supportive Care of
         Complementary and Alternative                    Patients and Survivors
3.5
         Approaches Prevention
                                                    6.9   Resources and Infrastructure
3.6      Resources and Infrastructure

                                                    Scientific Model Systems
Early Detection, Diagnosis & Prognosis

         Technology Development and/or                    Development and Characterisation of
4.1                                                 7.1
         Marker Discovery                                 Model Systems
         Technology and/or Marker
4.2                                                 7.2   Application of Model Systems
         Evaluation
         Technology and/or Marker Testing in
4.3                                                 7.3   Resources and Infrastructure
         a Clinical Setting

4.4      Resources and Infrastructure
Part 2                                                                      IN CONFIDENCE



3.4 - Specific keywords
Please list up to 20 specific keywords that you think best describes and categorises your
proposed research.
Part 2                                                                             IN CONFIDENCE



SECTION 4
                                   Equal Opportunities

Cancer Research UK operates a policy of equality of opportunity and fair treatment and aims
to ensure that unfair discrimination does not occur, especially on the grounds of gender,
marital status, race, colour, ethnic or national origins, disability, age (below the normal retiring
age), religious belief, sexual orientation or other. To help us monitor the effectiveness of our
policy, we ask you to complete this confidential questionnaire and return it with your form. We
understand that some applicants may hesitate to provide the personal details requested, but
please be assured that by completing this form you will be helping us ensure that all
applicants receive fair treatment. The questionnaire will be removed from your application and
the information you have provided will be used for statistical monitoring purposes only.
Cancer Research UK collects, stores and processes data in accordance with the terms of the
UK Data Protection Act 1998 (Registration no. Z6256472).

Please state your:
13.1 - Forename

13.2 - Last Name

13.3 - Title

                                      Development                 Clinical           Research
                                            Award                    Trial              Grant
13.4 - Are you applying for a:
                                        Fellowship           Studentship

13.5 - Is this your first application to Cancer Research UK?        Yes                     No
Please tick NO if you have previously applied to the Cancer Research Campaign or to the Imperial
Cancer Research Fund

13.6 - Date of Birth                                13.7 - Age at application

13.8 - Number of years of research experience

13.9 - Have you taken a break from your research career
                                                                    Yes                     No
for children / other reasons?
13.10 - Ethnic origin                       Bangladeshi                         Black – African
                                      Black – Caribbean                          Black – Other
                                                Chinese                                  Indian
                                               Pakistani                                  White

                                 Other (please describe)

13.11 - Nationality                       UK – English                    UK – Northern Irish
                                          UK – Scottish                         UK – Welsh

                                  Other (Please specify)

13.12 - Gender                                                     Male                Female

13.13 - Do you have a medical condition that might be
                                                                    Yes                     No
covered by the Disability Discrimination Act 1995?
      Part 2                                                                            IN CONFIDENCE




      SECTION 5
                              Full Economic Costing information

      AMRC member charities, which include Cancer Research UK, wish to monitor the full
      economic costs of the research they support. Unlike some other funding bodies, such as the
      research councils, and in line with other AMRC member charities, Cancer Research UK will
      not fund the full economic costs of research (fECs), or a proportion of these. However,
      Cancer Research UK and other AMRC charities are collecting information about the full costs
      of the research they support, in order to develop a better understanding of the charity
      contribution.

      Applicants and host institutions should note that the data sought is for monitoring purposes
      only and will not form part of the peer review or decision-making process that AMRC
      members use. All costs that contribute to the full economic costs for the entire duration of the
      project should be included in the table. Costs should be inflated at the recognised percentage
      rate currently used by the institution.

                                                             Full Economic         Cancer Research
                                                               Costs (£)           UK contribution (£)
        Directly Incurred Costs
        Staff
        Travel & Subsistence
        Other Costs
        Equipment
                                               Sub total
        Directly Allocated Costs
        Applicant Salary Costs
        Co-applicant Salary Costs
        Estates Costs
        Other Directly Allocated Costs
                                               Sub total
        Indirect Costs
        Other Costs
                                               Sub total
                                                TOTAL


      Proportion of time spent by applicants on research

        How many hours per week will the Principal Applicant and Coapplicant(s) spend on
        research?
(a)     Principal Applicant    Coapplicant 1        Coapplicant 2       Coapplicant 3       Coapplicant 4




(b)     How many hours per week will be spent on this project by the Principal Applicant and
        Coapplicant(s)?
        Principal Applicant    Coapplicant 1        Coapplicant 2       Coapplicant 3       Coapplicant 4




      Acceptance of this grant, if awarded, will imply that the institution is prepared to meet the full

								
To top