Grant application form

Introduction

The ESC will provide funding to support an individual, group, institute or organisation with a project that has a scientific basis with a described relevant outcome(s) and is related to the aims of the ESC. Examples include: research into methods or provision of contraception, sexual and reproductive health; validated questionnaires to understand uptake or utilization of a method or procedure; or needs assessment within a community or locale.

The ESC Science and Education Committee (SEC) retains the right to refuse an application if it feels the topic is not within the aims and objectives of the Society. For example, assisted reproductive technologies and projects on obstetric care would not be considered acceptable.

Application

Please use this on line application form. Note sections with a maximum word count. Forms will be returned if the word count is exceeded. Please complete ALL sections of the form.
If granted, the project MUST start within 12 months and MUST be completed within 3 years (if the project is to take longer, specific permission must be granted).
A mentor from the ESC will be allocated to each project. They are there to give advice if requested and will oversee progress.

Who can apply?

Applicants must be paid up ESC European members with their membership paid within a European country. However, a European applicant is allowed to submit a project that will take place outside Europe. You must remain a paid-up ESC member until the project is complete and has been signed off by the SEC.

Funding

Funding UP to a maximum of 10,000 euro per project can be requested. The money must be used for a definite project within a defined time period (usually up to 3 years) and with specified outcome measures. Part of the allocated funding is offered initially with the remainder being allocated on submission of an acceptable interim report(s). A final report MUST be sent to ESC within 6 months of completion.
A detailed budget must be included in the application form.

Deadline
Applications MUST be received at ESC Central office by 15th January 2023.

A. Name of the applicant requesting the funding

Name of applicant (principal investigator or leader of the project team)*

Job title*

Name of the institution or society who will administer the grant if successful (if no responsible organisation/ institution - please give justification for this)*

Name of all other co-investigators and institutions. (Please provide name, affiliation, position, and country)*

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Phone Number*

Area CodePhone Number

E-mail*

A short CV of the applicant (or the principal investigator or the team leader) should be provided here. (Max 2 pages)*

B. Proposed project

Is the person responsible for the project different to the person named in box A*

YesNo

Name of person

Job title

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Phone Number

Area CodePhone Number

E-mail

C. Background of the project – narrative summary

Title of the project*

Sector in the area of contraception, sexual and reproductive health:*

Please provide a comprehensive description of your project. The application will be assessed under the following headings: Background and rationale (with evidence of unmet need and innovation, relevance of the proposed project with contraception, sexual and reproductive health); Aims/ Objectives; Methodology (include where will it take place - country/town, establishment, sample size, justification, ethical approval plans (inclusion & exclusion criteria); Main outcome measures, statistical analyses); Impact it will or may have in the field of contraception, sexual and reproductive health (also under consideration of the situation in your country); Patient/ public involvement (where relevant) (1200 words)*

Planned start date and end date*

Timeline: Planned time for each phase of the project eg. approvals, recruitment, anylysis, reporting, dissemination? (Max 50 words)*

0/20

Is it a ‘new’ project? *

YesNo

If extension of an existing programme, provide information on original programme (give details) (Max 50 words)

0/50

D. Financial related information

How much will this project cost?

Are there other partners or organisations supporting this same project? *

YesNo

If YES - name the other partners who will support this project (Max 20 words)

0/20

Have you already obtained any funding?*

YesNo

Are you still awaiting a response towards this project? (Give details in the table below)*

YesNo

Details of your proposed budget

Example of costs include: staffing; involvement of a statistician; language editing; costs related to a questionnaire or obtaining relevant reference material. Costs for equipment may sometimes be accepted, dependent on the reason given. Receipts may be requested. Grant money cannot be used for congress registration.
List each item required for this project
For each budgetary item, enter either the amount requested from the ESC or if there is also funding from another partner, list the amount & name of partner.

Budget*

Total amount requested from ESC

Total amount requested from partner(s)

Add any additional information here

The ESC may not be in a position to fully fund all applications; you must indicate whether / how part funding may impact your project. (Max 100 words)*

0/100

Who will oversee the budget & keep accounts? Provide name, title, contact number and email address*

Note: The ESC retains the right to be refunded any unspent money from the grant.

E. Previous funding from ESC

If you or your department has received grant funding from ESC for a project or course before, please give details of the date of funding, contact person and title of project or course.

F. Follow up

I/We, as responsible agents for this project, agree to the following 11 points:*

	yes
I/We agree that all monies will be spent appropriately
I/We agree to work with the nominated Mentor
I/We agree to advise you at the earliest time if this project is delayed or cannot be completed
I/We agree to provide an interim report(s) part way through the project and a final report to the ESC within 6 months of the end of the project.
I/We agree to provide the ESC with an interim budget(s) and a detailed budget at the end of the project. NOTE funding will be awarded in stages and will be dependent on appropriate reporting.
I/We agree to provide receipts for monies spent if requested.
I/We agree that if we need to make any significant changes to the duration, contents or funding of the project after it has been awarded, I/we will advise the nominated mentor.
I/We agree that any unspent money will be returned to the ESC
I/We (the applicant) agree to acknowledge the ESC as a donor in any publications, submission of abstracts and oral communications resulting from this project. Please inform the ESC Office where and when the data is to be presented and/or published and note that ideally any manuscript should be sent to the ESC journal in the first instance.
I/We agree to remain fully paid up ESC member(s) until the final grant report is submitted
I/ We agree that the reports get published on the ESC website

Full Name

First NameLast Name

Submission date of this form*

DayMonthYear

Questions? ESC Central Office: info@escrh.eu / Tel. 0032 2 582 08 52