Download Research Grants Scheme – Application Form

Veterinary Council of Ireland Research Grants Scheme – Application Form
Please read the guidelines and terms and conditions before applying
Applicant’s Name
Address
Address for correspondence in
connection with this grant
application – if different
Telephone number(s)
Email address(es)
Position held (Including Institution
and department, if relevant)
If Registrant with VCI, give
registration number
Names and positions of coapplicants – not to exceed 3
Title of Research Project
Where will the research be
carried out?
Summary of research project
(<200 words)
Proposed start date
Estimated duration of the project
Grant amount being applied for
Form No.:
F.Reg.9.12.4
Rev.No.:
1
Date of Issue:
17/06/2014
Veterinary Council of Ireland, 53 Lansdowne Road, Ballsbridge, Dublin 4
 +353 (0)1 668 4402  +353 (0)1 660 4373  [email protected]  www.vci.ie
Veterinary Council of Ireland Research Grants Scheme – Application Form
Please read the guidelines and terms and conditions before applying
Details of the proposed research project
Title of the project
Discipline/subject area(s)
Describe the objectives and the
target outcomes of the research –
general and specific objectives and
targets should be outlined.
Please describe the proposed
work programme and research
methods.
Specify any interim targets or
stages in the proposed
programme.
What facilities will be required –
e.g. laboratory, equipment?
Please advise where these facilities
will be available.
Describe the expected value of
the proposed research to the
practice of veterinary medicine
and/or nursing.
How do you intend to disseminate
the results of the research?
Form No.:
F.Reg.9.12.4
Rev.No.:
1
Date of Issue:
17/06/2014
Veterinary Council of Ireland, 53 Lansdowne Road, Ballsbridge, Dublin 4
 +353 (0)1 668 4402  +353 (0)1 660 4373  [email protected]  www.vci.ie
Veterinary Council of Ireland Research Grants Scheme – Application Form
Please read the guidelines and terms and conditions before applying
Researcher / Research Institution details
To the Applicant – please
demonstrate that you have the
appropriate background and
knowledge to carry out this
research project. Citations of
publications etc. should be
appended to this application.
Please describe the qualifications,
backgrounds and relevant
experience of co-researchers – if
applicable.
Citations of other research
projects, publications etc. should
be appended to this application.
Please give contact details
(telephone and email) for the host
institution where the research
work will be carried out
Please give contact details
(telephone and email) for any
referee who is familiar with the
proposed research project
Form No.:
F.Reg.9.12.4
Rev.No.:
1
Date of Issue:
17/06/2014
Veterinary Council of Ireland, 53 Lansdowne Road, Ballsbridge, Dublin 4
 +353 (0)1 668 4402  +353 (0)1 660 4373  [email protected]  www.vci.ie
Veterinary Council of Ireland Research Grants Scheme – Application Form
Please read the guidelines and terms and conditions before applying
Research Cost Estimate and Funding
Total Project Time estimate
Item
Total
Applicant time on project – express in number of days
Co-researcher time on project – express in number of days
Total research days
Total Project Financial Cost estimate – show in €
Item
Total
Facilities, equipment
Materials
Travel, etc.
Total
Please show how the grant sought will be used – show in €
Item
Total
Facilities, equipment
Materials
Travel, etc.
Total
Please show how the balance of the project costs will be funded – show in €
Source of Funding
Total
Source A (Name)
Source B (Name)
Total
Form No.:
F.Reg.9.12.4
Rev.No.:
1
Date of Issue:
17/06/2014
Veterinary Council of Ireland, 53 Lansdowne Road, Ballsbridge, Dublin 4
 +353 (0)1 668 4402  +353 (0)1 660 4373  [email protected]  www.vci.ie
Veterinary Council of Ireland Research Grants Scheme – Application Form
Please read the guidelines and terms and conditions before applying
Ethics
Does your research project involve any of the following?
 Tick as appropriate
Yes
No
Animals as the research focus
Research on animals, animal samples and/or data
Research outputs with implications for animals
Research outputs with implications for veterinary
professionals
Humans as the research focus
Human samples and/or data
Humans involved as consumers or users
Research outputs with implications for humans
What ethical issues have been identified and describe what considerations have been
given to these? (Please note that you are expected to have taken due consideration of all
issues around ethical, licensing and consent for the research, and have licences for any
animal experiments that require the approval of the Health Products Regulatory Authority.)
Form No.:
F.Reg.9.12.4
Rev.No.:
1
Date of Issue:
17/06/2014
Veterinary Council of Ireland, 53 Lansdowne Road, Ballsbridge, Dublin 4
 +353 (0)1 668 4402  +353 (0)1 660 4373  [email protected]  www.vci.ie
Veterinary Council of Ireland Research Grants Scheme – Application Form
Please read the guidelines and terms and conditions before applying
Undertakings
Applicant
I/we hereby apply to the Veterinary Council of Ireland for grant funding towards the costs of
the research project described herein.
I/we have read the terms and conditions of grant. I/we agree to be bound by these.
Signed ________________________________________
_________________________________________
_________________________________________
Accredited Course Provider
I/we agree to co-operate in the research project described herein and to provide the
support and facilities as described.
Signed
_________________________________________
Position
_________________________________________
Institution
_________________________________________
Form No.:
F.Reg.9.12.4
Rev.No.:
1
Date of Issue:
17/06/2014
Veterinary Council of Ireland, 53 Lansdowne Road, Ballsbridge, Dublin 4
 +353 (0)1 668 4402  +353 (0)1 660 4373  [email protected]  www.vci.ie