RN Application

Member submitting application on behalf of the team and email: *

Employing organisation: *

Region/deanery: *

Full Name (Including Title) of members of the Urogynaecology Unit with qualifications, telephone contacts and email: *

Are you part of the CRN (Clinical Research Network)? *

Do you have research fellows/ research nurses in your department to assist in the running of multicentre studies? (State Numbers for each) *

Do you have a Research administrator for Obstetrics and Gynaecology who deals with all studies being set up in the department? (Named person with contact details) *

Have you experience of recruiting to Multicentre studies?Past 3 National studies recruited to and Number of patients to each study. Were the Recruitment Targets met? *

Have you been an applicant/co-applicant on a National Grant? Give details *

List and details of Publications in the past 3 years: *

Research interests by team member: *

Application form to be submitted by 10 am on the 18th September 2020.

Supporting Statement

1. Please provide a statement supporting your team application to the Research Network including why you are applying and your relevant track record. Please make reference to the terms of reference for the RN and provide examples of how you meet these.
(No more than 250 words)

2. Please provide a brief CV of all members in the Unit (on one side of A4 each) and submit with the application form.

Supporting Statement *

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Supporting CV *

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Declaration of good standing

I confirm that my name is NOT currently removed from the Medical Register in any country nor have any conditions been applied.

Signature of member submitting on behalf of the team *

Clear