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HEALTH AND CARE RESEARCH WALES RESEARCH DEVELOPMENT INFRASTRUCTURE
FUNDING CALL2019
APPLICATION FORM
Please complete this form electronically, expanding each section as appropriate.
SECTION A: BASIC INFORMATION
A1. Lead Applicant details:Name
InstitutionAddress
E-mailTel
A2. Name of group for which you are requesting funding
A3. Funding amount requested from Health and Care Research Wales
April 2020 – March 2023
£
April 2023 – March 2025
£
Total £
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A4. Summary of funding application
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A5. Co-applicant details: (add or delete as appropriate)
NameInstitution
AddressE-mail
TelRole
(Max 50 words)
NameInstitution
AddressE-mail
TelRole
(Max 50 words)
NameInstitution
AddressE-mail
TelRole
(Max 50 words)
NameInstitution
AddressE-mail
TelRole
(Max 50 words)
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A6. Other Collaborators: (add or delete as appropriate)
NameInstitution
AddressE-mail
TelNature of
engagement (Max 50
words)
NameInstitution
AddressE-mail
TelNature of
engagement (Max 50
words)
NameInstitution
AddressE-mail
TelNature of
engagement (Max 50
words)
NameInstitution
AddressE-mail
TelNature of
engagement (Max 50
words)
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SECTION B: WORK PROGRAMME AND CASE FOR SUPPORT
B1: Please describe your proposed area/s of research activity.
B2: Please describe the infrastructure resource gap you have identified.
B3: Please describe the various activities (work packages) that make up your work programme, indicating the rationale and expected outputs for each work package. (1,000 words)
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B4: Please describe the benefits you believe will accrue both to your group and health and care research in Wales, should your application be successful.
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SECTION C: COLLABORATION AND ENGAGEMENT
C1. Please describe how you will engage and collaborate effectively with relevant health and social care services, commercial and third sector organisations. (1,000 words)
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C2: How do you see your role and place within a Health and Social Care research development infrastructure?
C3: Please describe the alignment you see between your work programme and current Welsh Government policy and its associated strategies.
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SECTION D: PUBLIC INVOLVEMENT AND ENGAGEMENT
D1. Please outline your plans to involve the public in your work programme, and describe the benefits that this will bring. (750 words)
D2. Please outline your plans and activities to engage with the public and describe the benefits you think your public engagement activities will bring. (750 words)
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SECTION E: OUTPUTS AND PATHWAYS TO IMPACT
E1: Please describe the immediate outputs and the anticipated short, medium and longer term outcomes of your work programme. (1,000 words)
E2: What impact would you expect to have beyond research and academia within the (five year) term of your grant award?
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SECTION F: LEADERSHIP AND GOVERNANCE
F1. Leadership: Please describe your leadership and management structure, indicating the experience and expertise you have in leading and managing work programmes of this kind.
F2: Governance arrangements: Please describe the governance arrangements you wish to put in place to support the activity funded through this grant. In particular, please describe the proposed role and membership of any advisory or strategy groups you intend to create.
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SECTION G: EQUALITY AND DIVERSITY
G1. Please describe how you will ensure adequate and appropriate equality and diversity within your group and across its work programmes.
G2. Please indicate the Athena SWAN status of the Higher Education Institutions (HEIs) involved in your bid as host/employing institutions of both the Lead and the Co-applicants. If the HEIs concerned have not achieved Silver Award status, please provide evidence of progress towards this.
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SECTION H: RESOURCES
H1. Financial Profile and Cost Breakdown: April 2020 – March 2023
Year 1(2020-21)
£
Year 2(2021-22)
£
Year 3(2022-2023)
£
Total(Years 1-3)
£Staff costs
Overheads* N/A N/A N/A N/A
Consumables and Equipment
Staff Training/development
Public Involvement
Public Engagement
General dissemination and engagement (e.g. events and conferences)
Travel and subsistence
Other (please specify)
TOTAL
VAT (if applicable)
Grand total
*As noted in the guidance, we are seeking the waiving of overheads as the most appropriate form of institutional commitment. Overheads should not, therefore, feature in this table. Please see guidance notes on resources and institutional commitment for further explanation.
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H2: Financial Profile and Cost Breakdown: April 2023 – March 2025
Year 4(2023-2024)
£
Year 5(2024-2025)
£
Total (Years 4-5)
Staff costs
Overheads*N/A N/A N/A
Consumables and Equipment
Staff Training/development
Public Involvement
Public Engagement
General dissemination and engagement (e.g. events and conferences)
Travel and subsistence
Other (please specify)
TOTAL
VAT (if applicable)
Grand total
*As noted in the guidance, we are seeking the waiving of overheads as the most appropriate form of institutional commitment. Overheads should not, therefore, feature in this table. Please see guidance notes on resources and institutional commitment for further explanation.
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H3. Justification of resources
H4. Institutional commitment (Lead and Co-applicant organisations)
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H5. Other match-funding/resource support
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SECTION I: DECLARATIONS and CVs
I1: To be signed by the Lead Applicant
This is my application for Health and Care Research Wales Research Development Infrastructure funding call 2019. If my application is successful it is my intention to manage the grant and associated work programme in line with the information provided on this form. My institution is aware of my intention and supports my application for funding. I confirm that all co-applicants, institutions and collaborators named on this form have been approached and have agreed to their inclusion.
Name:
Institution:
Signed:
Date:
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I2: To be signed by the Lead Applicant’s Head of Department/Head of School and an authorised signatory from the administration of the Lead Applicant’s institution
I confirm that I have read this document and that the work described will be accommodated and administered within this body in accordance with the agreed terms and conditions set out in the Grant Award letter for as long as funding is provided. All stated costs are correct at the time of submission and in accordance with the normal practice of this institution. I confirm that the institution is committed to supporting this application and will waive overheads in accordance with the response to Question H4.
Head of Department/Head of School:
Name:
Title:
Signed:
Date:
Administrative Authority:
Name:
Title:
Signed:
Date:
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I3: To be signed by all Co-applicants (please replicate as necessary)
I confirm that I have read this application for funding and agree to my inclusion as a co-applicant. I will contribute to the work programme described in accordance with the description of my role provided in response to Question A4. My institution is aware of, and supports, my inclusion and participation. I confirm that the institution is committed to supporting this application and has agreed to waive overheads in accordance with the response to Question H4.
Name: Signed:
Title: Date:
Name: Signed:
Title: Date:
Name: Signed:
Title: Date:
Name: Signed:
Title: Date:
Name: Signed:
Title: Date:
Name: Signed:
Title: Date:
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I4: Lead and Co-applicant CVs (Maximum two sides A4)
Lead Applicant CV
Personal detailsTitle:Name:Institution:Address:
Phone:E-mail:
Current post:
Research experience
Qualifications:
Work history:(Please provide relevant dates and description of role/s)
Significant grants won:
Publications:
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Co-applicant #1 (duplicate as necessary)
Personal detailsTitle:Name:Institution:Address:
Phone:E-mail:
Current post:
Research or other relevant experience
Qualifications:
Work history:(Please provide relevant dates and description of role/s)
Significant grants won:
Publications:
Other:
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Privacy notice – Welsh Government grants
The Welsh Government provides a wide range of grant schemes to help deliver our policies and create a fairer, more prosperous Wales.
The Welsh Government will be data controller for any personal data you provide in relation to your grant application or request for grant funding. The information will be processed as part of our public task (i.e. exercising our official authority to undertake the core role and functions of the Welsh Government) and will help us assess your eligibility for funding.
Before we provide grant funding to you, we undertake checks for the purposes of preventing fraud and money laundering, and to verify your identity. These checks require us to process personal data about you to third party fraud prevention agencies.
If we, or a fraud prevention agency, determine that you pose a fraud or money laundering risk, we may refuse to provide the grant funding you applied for, or we may stop providing existing grant funding to you.
A record of any fraud or money laundering risk will be retained by the fraud prevention agencies, and may result in others refusing to provide services, financing or employment to you.
We will keep personal information contained in files in line with our retention policy. If successful in your application then your personal data will be kept for 7 years after the date when you, as grant recipient, are free from all conditions relating to the grant awarded and all payment have been made. However, if the funding is awarded under General Block Exemption or De Minimis, your personal data will be kept for 10 years from the conclusion of any aid award. If you are unsuccessful your details will be kept for one year after the date you provided them.
Under the data protection legislation, you have the right: to access the personal data the Welsh Government holds on you require us to rectify inaccuracies in that data to (in certain circumstances) object to or restrict processing for (in certain circumstances) your data to be ‘erased’ to lodge a complaint with the Information Commissioner’s Office (ICO)
who is the independent regulator for data protection
For further details about the information the Welsh Government holds and its use, or if you want to exercise your rights under the GDPR, please see contact details below:
Data Protection Officer:
Welsh Government Cathays Park
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CARDIFF CF10 3NQ
Email Address: [email protected]
The contact details for the Information Commissioner’s Office are:
Wycliffe House Water Lane Wilmslow Cheshire SK9 5AF
Telephone: 01625 545 745 or 0303 123 1113
Website: www.ico.gov.uk
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Annexes
Annex 1: Expression of ‘intent to apply’ form
www.healthandcareresearch.gov.wales/uploads/News/03.Infrastructure_Call_expression_Intent_to_Apply_Form_annex1.doc/ (This link will download the form)
Annex 2: Detailed financial profile and cost breakdown from April 2020 to March 2025
www.healthandcareresearch.gov.wales/uploads/News/04.Infrastructure_Call_Detailed_Financial_Profile_Cost_breakdown_annex2.xls (This link will download the document)
Annex 3: Application checklist
Sections To check Complete
Annex 1Expression of intent to apply submitted by 11th March 2019
A1 – I4
All sections of the application have been fully completed, where appropriate, in accordance with the guidance document.
A1 – I4 Ensure word count on application within limits
H1 – H2 Financial profile and cost breakdowns
I1 Application signed by Lead Applicant
I2
Signed by the Lead Applicant’s Head of Department/Head of School and an authorised signatory from the administration of the Lead Applicant’s institution
I3 Signed by all Co-applicants
I4Lead and Co-applicant CVs – must not exceed sides of A4
Annex 2Detailed cost breakdown spreadsheet has been completed
Application submitted by host institution/organisation
Provided one signed copy and an electronic copy of form by 5pm on Friday 12th April 2019
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Please note: All of the above documents in the Annexes are available through the Research Development Infrastructure Funding Call 2019 advertisement on the Health and Care Research website at: www.healthandcareresearch.gov.wales/news/research-development-infrastructure-funding-call-2019/
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