Application for a research grant from LIVErNORTH
Pump Priming Grant (<£10k)
Please type your application into the spaces provided. Do not use font size lower than 11pt. Return this form electronically to: info@livernorth.org.uk
If you have not received electronic confirmation of receipt within three days of submission then contact LIVErNORTH on 0191 3702961.
The fields used in application assessment can be seen at the end of the document.
PART ONE
1. Applicants
Title
Surname Forename
Age Post Held
Applicant 1 Applicant 2 Applicant 3
If there are more than three applicants then please attach an additional page.
2. Institution that will be administering the grant
Name
Address where the work will be undertaken
Project # or reference
3. Title of the Study
4. Abstract and methodological description of the study (do not exceed four pages)
5. Brief Abstract (500 words). Please describe the background, methodology scope of your work in non-
medical terms. Include how your work will help patients in the future.
6. Costings
7. Proposed Timetable
8. Provide details of ethical approval. If no approval needed please explain why.
9. Institutional approval information
10. Declaration
I confirm that I have read this application and that if a grant is awarded the work will be accommodated and administered in our institution.
Principal Investigator
Head of Department
PUMP PRIMING RESEARCH GRANT APPLICATION PEER ASSESSMENT
Date:
Reviewer:
Application:
Importance and potential of the work (0-10)
Research environment and people (0-10)
Research outline, plan and methods (0-10)
Justification for resources requested (0-10)
Approvals and research governance (0-10)
Comments:
OVERALL SCORE (out of 50)