VicTAG Research Grant Proposal

Who is the Chief Investigator
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Project Title(*)
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Please provide a title that is clear, precise and informative to workers outside your field

Project Synopsis (*)
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Present a short succinct summary outlining your proposed project. The synopsis should explain the purpose of the project and describe what the project will do.

Investigating Team

Please provide a brief CV as outlined below for each of the investigators. The Chief Investigator is responsible for the management of the project and will be regarded as the contact person.

Chief Investigator:
Name(*)
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Address(*)
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Telephone(*)
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Facsimile(*)
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Email(*)
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Current Employment
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Summary of Previous Employment (brief outline of positions held):
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Academic Qualifications
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Area of Expertise
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Membership of Professional Societies / Groups
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Membership of Professional Committees
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Previous grants (include name of grant, purpose, grant amount, date granted):
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Prizes and Awards
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Publications (limit to five most recent publications):
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Co-Investigator 1
Name
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Address
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Telephone
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Facsimile
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Email
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Current Employment
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Summary of Previous Employment (brief outline of positions held):
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Academic Qualifications
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Area of Expertise
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Membership of Professional Societies / Groups
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Membership of Professional Committees
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Previous grants (include name of grant, purpose, grant amount, date granted):
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Prizes and Awards
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Publications (limit to five most recent publications):
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Co-Investigator 2
Name
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Address
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Telephone
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Facsimile
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Email
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Current Employment
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Summary of Previous Employment (brief outline of positions held):
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Academic Qualifications
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Area of Expertise
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Membership of Professional Societies / Groups
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Membership of Professional Committees
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Previous grants (include name of grant, purpose, grant amount, date granted):
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Prizes and Awards
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Publications (limit to five most recent publications):
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Co-Investigator 3
Name
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Address
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Telephone
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Facsimile
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Email
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Current Employment
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Summary of Previous Employment (brief outline of positions held):
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Academic Qualifications
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Area of Expertise
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Membership of Professional Societies / Groups
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Membership of Professional Committees
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Previous grants (include name of grant, purpose, grant amount, date granted):
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Prizes and Awards
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Publications (limit to five most recent publications):
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Co-Investigator 4
Name
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Address
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Telephone
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Facsimile
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Email
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Current Employment
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Summary of Previous Employment (brief outline of positions held):
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Academic Qualifications
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Area of Expertise
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Membership of Professional Societies / Groups
Invalid Input

Membership of Professional Committees
Invalid Input

Previous grants (include name of grant, purpose, grant amount, date granted):
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Prizes and Awards
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Publications (limit to five most recent publications):
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Project Details

A maximum of five pages should be used
Aims and Objectives
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Clearly define the objectives of the project

Hypotheses
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Background (with references)
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Provide a rationale for the project and detail research already done on the topic

Methodology
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Provide details of project design, group / population to be researched or sampled, evaluation methodology, statistical analysis

Timetable
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Include likely start and finish dates as well as project timetable

Expected Outcomes
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Describe the outcomes you expect to be available at the end of the project.

Dissemination
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Describe how the results / project outcomes will be disseminated.

Proposed Grant Budget

Applicants must provide a detailed project budget. This pro-forma is to be used as a guide for completing a budget for the overall project. PLEASE NOTE: Not all items will be applicable for funding; these are examples only.
Name
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Project Title
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Registration / Course Fees
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Accommodation Expenses
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Travel Expenses (e.g. air, taxis, bus, train)
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Salaries (e.g. Project Officer; Locum/Backfill Costs – for preceptorships in particular)
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Project Management Resource Details and Associated Costs (e.g. salaries or charges for technical assistance for statistical analysis or IT support) $
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Materials/Consumables/Equipment Expenses (e.g. books/study material; assay equipment; computer hardware or software)
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Other/Miscellaneous Expenses (e.g. ethics fees; stationery; photocopying; printing of leaflets/brochures/posters)
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Other
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Other
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Total Funds Requested
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Declaration of other Financial Support

To facilitate coordination with other funding bodies, and to optimise use of available funds, applicants are asked to advise if funding has been, or is being, sought from other sources.
Have you obtained other financial support for this research project?
If yes, other source(s)
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If no, are you applying for other support:
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If yes, give details
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Please note: if additional funds are obtained from other sources after this application has been considered, applicants must immediately inform VicTAG. Failure to disclose full information may result in an application being rejected.

Leave Considerations

Is absence from your employment necessary?
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If yes, give details
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Please note: if additional funds are obtained from other sources after this application has been considered, applicants must immediately inform VicTAG. Failure to disclose full information may result in an application being rejected.

Referee (one external referee)

Applicants should note that Referee Report Form is to be returned no later than the advised closing date.
You will need to provide the referee with a copy of your application and sufficient information so they may assess the grant.
It is the applicant’s responsibility to forward the Referee Report Form to their nominated referee to complete and request that the form be returned directly to:
greg@barwonhealth.org.au
 

Statement of Head of Department

support the application:
Name
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Position
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Upload Signature
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Date

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Certification by Applicant

I understand and agree that if my application for a grant is successful the grant will be made on condition that I will do everything reasonably within my power to ensure that the funding granted by VicTAG is acknowledged in any:
  • Publication
  • Announcement to the public for the medical or scientific community
  • Statement to the media
  • Lecture or seminar relating to the project (whether or not it also relates to other matters).

I also understand / agree that I shall submit a final report in the required format and any progress reports as may be requested by VicTAG.
agree if successful in obtaining grant funding that my name, workplace and state may be mentioned in news bulletins associated with the grant/award.
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Ethical Implications

Research projects involving patients and patient data will require institutional ethics committee approval before funds are released.
Have you included
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Have you forwarded
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You must submit the application electronically as well as all supporting documentation
to: Greg Weeks - Secretary VicTAG
greg@barwonhealth.org.au

APPLICATIONS MUST COMPLY WITH ALL GRANT CONDITIONS OR THEY WILL BE RETURNED TO THE APPLICANT WITHOUT REVIEW

 

VicTAG Research Project GRANT REFEREE REPORT FORM

Name
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ORGANISATION
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POSITION
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AREA OF EXPERTISE
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EMAIL ADDRESS
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APPLICANT’S NAME
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PROJECT TITLE
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AREA OF EXPERTISE
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VicTAG PROJECTS
Please give brief details of your assessment of the applicant’s proposed research project with regard to the following
APPROPRIATENESS OF METHODOLOGY
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RELEVANCE
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Please comment on the relevance of the proposal to the advancement of hospital pharmacy or health care.

SIGNIFICANCE & ORIGINALITY
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How would you rate the significance and originality of the proposal

COMPLETION
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Is the proposal likely to be completed as outlined (with reference to time frame, budget) Comment on ability of applicant to complete the project.

LIMITATIONS
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Do you consider their are any limitations to the project? Are their any issues of relevance not identified? If so please outline.

OTHER COMMENTS
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Any other pertinent comments that will assist the committee reach a decision. (Include here areas where the application could be improved).

RATING
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How would you rate this application? (please tick appropriate box)

FUNDING RECOMMENDATIONS
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(please tick appropriate box)

Partial Funding Amount
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Input amount for Partial Funding

Referee's Signature
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Upload Referee's Signature

Captcha(*)
Captcha
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