PSPA Small Grant Application Form

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Page 1

Title of Project

Lead Applicant Information

Lead Applicant Title

Lead Applicant First Name

Lead Applicant Last Name

Lead Applicant Job title/Career Stage

Lead Address Street

Lead Address Town / City

Lead Address County

Lead Address Postcode

Lead Applicant Work Email

Lead Applicant Mobile Number

Lead Applicant Work Phone

Lead Applicant Preferred Phone

Sex

Ethnicity

Pronouns

Do you have a disability?

How did you hear about PSPA

Introduction From

Lead Applicant's Communication Preferences

Please select all the ways you would like to be contacted:

I would like to receive communications by email

I would like to receive communications by post

I would like to be contacted by phone

I do not wish to be contacted by PSPA

You can change your marketing options at any time by contacting us by email: consent@pspassociation.org.uk; telephoning us on 01327 322 410; or writing to us at PSPA, Margaret Powell House, 415a Midsummer Boulevard, Milton Keynes, MK9 3BN.

Main Collaborators Information

Main Collaborators Title

Main Collaborators First Name

Main Collaborators Last Name

Main Collaborators Job Title

What role do they have in the project

Main Collaborators Organisation Name

Main Collaborators Address Street

Main Collaborators Address Town / City

Main Collaborators Address County

Main Collaborators Address Postcode

Main Collaborators Work Email

Main Collaborators Mobile Number

Main Collaborators Work Phone

Main Collaborators Preferred Phone

If there are any additional Collaborators on this project, please add their title, first and last name together with their email address below:

Research Institution / Organisation

Research Institution / Organisation Name

Finance Officer Name

Research Institution / Organisation Phone

Research Institution / Organisation Email

Institute / Organisation Address Street

Institute / Organisation Address Town / City

Institute / Organisation Address County

Institute / Organisation Address Postcode

Registered charity number England and Wales 1037087 and Scotland SCO41199

Page 2

The Project

Proposed Start Date

Duration in Months

Total hours per week worked on project:

Total Amount Requested from PSPA

Abstract of research (Up to a maximum 250 words, please summarise the central research question, key aims, methodology, and the scientific and clinical implications of the study).

Lay summary (maximum 250 words, explain to a lay audience the nature of the proposed research. This must include the expected benefits in terms of improvement to human health, with an estimate of the time frame to any clinical translation).

Details of the project (maximum 1500 words)

Include (a) Hypotheses (b) Background to the proposal (c) Experimental design and methods (ensure sufficient detail, including a statement on power calculation where relevant) (d) Timetable with key milestones, (e) Potential barriers or risks.

Bibliography (maximum 20 references, numbered consecutively as they appear in the text, including first author only, title, journal, year, pagination and PMID).

Relevance to PSPA Strategy (maximum 150 words). Please summarise how the proposed project meets the PSPA Research Strategy.

Co-Funders

Co-Funded Research Name

Total Amount Requested from Co-Funder

Page 4

Finance

A. Salary Costs

The Grant Holder is responsible for the costs of pension contributions, National Insurance, apprenticeship levy and any additional benefits which are made available through the institution.

Costs should include any collaborator salary costs.

Brief Description (name, role)	Year 1	Year 2	Total £

B. Research Costs

Brief Description of Item	Year 1	Year 2	Total £

C. Equipment
(NB: Avoid generic terms e.g. consumables)

Brief description of items	Basic Price £	Total £

D. Other Costs

Description	Year 1	Year 2	Total £

Summary

	Year 1	Year 2	Total £
Total Salary (A Above)
Total Research(B above)
Total Equipment (C above)
Total Other (D above)
Final Total

Justification of costs - Justify all financial resources requested (maximum 500 words)

Peer-Review Process

Please use this box to list potential reviewers that you do NOT want to be involved in reviewing your application (maximum 4 names)

Page 5

Supporting Statements, Declarations and Signatures

By ticking this box, as the Lead Applicant, I am prepared to present written documentation if requested.

Lead Applicant

Lead Title

Lead Applicant First Name

Lead Applicant Surname

I undertake and manage the ProjectI declare that all involved are aware of the submissionI declare the information provided is accurateI will ensure timely submission of progress and final reports

Date

By submitting this form, I understand that as the Lead Applicant, it counts as my signature

Collaborator

Main Collaborators Title

Main Collaborators First Name

Main Collaborators Last Name

Main Collaborators Supporting Statements

Date

By submitting this form, I understand that it counts as my signature

Head of Department

Head of Departments Title

Head of Departments First Name

Head of Departments Last Name

Head of Departments Supporting Statement

Date

By submitting this form, I understand that it counts as my signature

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