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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